| NPI | 1639634512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYSHA DETREESE JONES Owner 346-254-4665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 171W00000X Contractor |
| 305S00000X Point of Service | |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2023-01-25 |