| NPI | 1740595347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD EDWARDS Contract Administrator 9197-838-8898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility Assisted Living, Mental Illness |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2015-11-20 |