| NPI | 1699580332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK FISK Director / Administrator 949-998-9191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2025-02-10 |
| Last Update Date | 2025-02-10 |