| NPI | 1659196525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES, SIEDAH, BEV TILLMAN JR, WILLIS,BOSWELL Owners 414-779-7188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2024-11-18 |