| NPI | 1790230936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELVIN L FRANK Member 218-205-0426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MN applied) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2016-08-17 |