| NPI | 1346006194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAISE BUQUIRAN DELA PENA Manager 928-546-4584 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2024-02-27 |