| NPI | 1568841203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH JAMES GREEN General Manager/Administrator 469-387-9632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |