| NPI | 1366957961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 310400000X Assisted Living Facility | |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2023-12-05 |