| NPI | 1831956176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANISHA WILSON Director 267-357-9124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 177F00000X Lodging |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2024-03-05 |