| NPI | 1518301993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE BERGSTROM Doctor 219-747-2995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: MN 362242) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2013-04-29 |