| NPI | 1508548819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI MOORE Administrator 701-290-0690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility |
| Additional Taxonomies | 385H00000X Respite Care |
| Enumeration Date | 2023-08-04 |
| Last Update Date | 2023-10-16 |