| NPI | 1730934696 |
|---|---|
| Doing Business As | NA |
| Entity Type | Organization |
| Authorized Contact | MARYAN DUALLE Owner 161-481-5900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2024-04-23 |
| Last Update Date | 2024-04-23 |