| NPI | 1487802450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK F WICKER President 218-249-1144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MN 1052308) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2024-05-16 |