| NPI | 1790478329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OPHELIA KPEWOAN Owner 763-516-8545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 3104A0625X Assisted Living Facility Assisted Living, Mental Illness |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2023-05-31 |