| NPI | 1578720157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA DEE IVERSON Owner/ Provider 253-638-8338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WA 648700) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2008-05-21 |