| NPI | 1710010202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIROS TESFAYE Business Manager 657-647-0017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: MN 457435400) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-08-22 |