| NPI | 1942586532 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: MN 354457) |
| Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: MN FBL-26096-34148) |
| 311ZA0620X Custodial Care Facility Adult Care Home (Licence: MN 354448) | |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2011-10-26 |