| NPI | 1578190138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC TUYISHIME Managing Member 574-904-0586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2020-03-24 |