| NPI | 1669935102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA DAVIS Administrator 269-348-6217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 174200000X Meals |
| 251E00000X Home Health | |
| 253Z00000X In Home Supportive Care | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2019-04-11 |