| NPI | 1760192702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MASSARA GOYOM KOMJO Owner 515-918-3551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 174200000X Meals |
| 251E00000X Home Health | |
| 273Y00000X Rehabilitation Unit | |
| 282E00000X | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2025-01-07 |