| NPI | 1649978479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON M BENSON Vice President 715-559-9830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2023-02-21 |