| NPI | 1700201118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA M COWANS Stna 216-205-1093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: OH 400171191002) |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Mentally Retarded (Licence: OH 400171191002) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2014-02-21 |