| NPI | 1437700499 |
|---|---|
| Former Name | AMANDA SUE BECKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MN 1100892) |
| Enumeration Date | 2019-09-21 |
| Last Update Date | 2019-09-21 |