| NPI | 1326430117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT CRETSINGER Owner/Licensee 269-579-7512 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: MI AM130065138) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2016-07-01 |