| NPI | 1447896790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASPER MUKWADA Administrator 269-267-9739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2022-07-08 |