| NPI | 1760965081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW JOHNSON President 209-276-8892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2020-09-26 |