| NPI | 1407472707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYONG SUK LEE Administrator 909-618-7575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2020-06-22 |