| NPI | 1902107444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISHMAEL RIDEAUX Owner 708-516-3656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: AZ 09353 Susan Reily) |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2010-11-16 |