| NPI | 1407158884 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: NC 017059) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 381) |
| 3104A0625X Assisted Living Facility Assisted Living, Mental Illness (Licence: NC 017059) | |
| 3104A0630X Assisted Living Facility Assisted Living, Behavioral Disturbances (Licence: NC 017059) | |
| 310500000X Intermediate Care Facility, Mental Illness (Licence: NC 017059) | |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2022-02-08 |