| NPI | 1528864162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN WAYNE SMITH Cco 507-536-9221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-02-24 |