| NPI | 1669847075 |
|---|---|
| Doing Business As | YOUR HOME AT THE LAKE |
| Entity Type | Organization |
| Authorized Contact | BARBARA JENSEN Owner 218-495-2625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2015-12-10 |