| NPI | 1407115645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NINA MOORE Administrator 712-260-7552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 310400000X Assisted Living Facility (Licence: IA 732689) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2012-11-05 |