| NPI | 1639724107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY HUSTED Owner/President 614-329-8428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2019-08-01 |