| NPI | 1740491851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIEDERICK VAN DER VELDE Owner 812-280-0965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: IN 070108851) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |