NPI | 1346714425 |
---|---|
Entity Type | Organization |
Authorized Contact | WAYNE VINCENT KILTHAU Licensee 669-234-3344 |
Organization Subpart ? | No |
Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded |
Enumeration Date | 2019-01-11 |
Last Update Date | 2019-01-11 |