| NPI | 1568230316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BREANNA WICKER Administrator 316-737-7207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2023-12-12 |
| Last Update Date | 2023-12-12 |