| NPI | 1487067153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLY JAMES ELY Director Of Nursing 651-600-3869 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |