| NPI | 1619864287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRA LYNN SCOTT Owner 267-776-5462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 251G00000X Hospice Care, Community Based |
| Enumeration Date | 2025-06-18 |
| Last Update Date | 2025-06-18 |