| NPI | 1841073244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CEDRIC D MUTSIAMBO Gm 831-643-5516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility |
| Additional Taxonomies | 251S00000X |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2023-08-17 |