| NPI | 1558798397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PROSPER KOMLA DZAMESHIE Administrator 651-917-5519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2013-10-10 |
| Last Update Date | 2017-03-07 |