| NPI | 1316776628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: CA 435294143) |
| Additional Taxonomies | 251S00000X (Licence: CA 435294143) |
| 310400000X Assisted Living Facility | |
| 310400000X Assisted Living Facility (Licence: CA 435294143) | |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances (Licence: CA 435294143) | |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: CA 435294143) | |
| Enumeration Date | 2024-07-26 |
| Last Update Date | 2024-07-26 |