| NPI | 1366110314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANCES MARIE WAGNER License Designer 616-712-6002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2021-09-03 |