| NPI | 1740864172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANNE OMOAHOLO Owner/Manager 607-592-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2021-05-11 |