| NPI | 1346790110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERODD TAYLOR Owner 262-880-5606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WI 0016034) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2016-10-05 |