| NPI | 1710366919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKESHIA JEANNETTE COOPER Owner 631-842-1639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NY 00287717) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2015-05-21 |