NPI | 1669422804 |
---|---|
Entity Type | Organization |
Authorized Contact | PAMELA DEPREZ Owner 765-521-4110 |
Organization Subpart ? | No |
Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IL 050011301) |
Enumeration Date | 2006-05-10 |
Last Update Date | 2020-08-22 |