| NPI | 1770754590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY DAMERON Boss 360-260-9002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WA 427401) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2008-03-19 |