| NPI | 1588709976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY RANDEL Administrator 641-755-2125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: IA R - 695) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-08-22 |