| NPI | 1285332809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEIDRE MICHELLE LEWIS Owner Manager 314-691-3189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2023-02-22 |