| NPI | 1407984081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE E STUBSON CFO 2182-912-2216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: ND 63) |
| Additional Taxonomies | 311500000X Alzheimer Center (Dementia Center) (Licence: ND 8100A) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |