| NPI | 1760796437 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: NY 504304) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: NY 504304) |
| 311Z00000X Custodial Care Facility (Licence: NY 504304) | |
| 311ZA0620X Custodial Care Facility Adult Care Home (Licence: NY 504304) | |
| 3140N1450X Skilled Nursing Facility Nursing Care, Pediatric | |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2010-08-04 |