| NPI | 1790175578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTY COWAN-KILLCREASE Managing Member 318-608-8088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2015-01-30 |