| NPI | 1275397945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONN RAMON ORTIZO LIGASON Owner 386-341-1486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-02-12 |