| NPI | 1942639521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRENE F HALDER Licensee/Owner 269-473-6006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: MI AF110320288) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2013-11-05 |