| NPI | 1275814121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY ANN KYDD Provider 360-790-2863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: WA 752014) |
| Additional Taxonomies | 385H00000X Respite Care (Licence: WA 752014) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2011-09-06 |