| NPI | 1407303662 |
|---|---|
| Other Name | TIFFANY LEEANNE REISCH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: MN APPLIED) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2016-09-06 |