| NPI | 1285512681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAH RENE RODRIGUEZ Owner 262-822-5305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2025-09-15 |