| NPI | 1447093752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA OTA Director 267-237-6579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2024-06-14 |