| NPI | 1710355821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY EBOH Cna 646-305-8048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NY 323040) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2015-09-04 |