| NPI | 1770223893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNIE DENHAM Administrator 800-993-1287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 251E00000X Home Health |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-03-29 |