| NPI | 1962042895 |
|---|---|
| Doing Business As | 3419 54TH ST |
| Entity Type | Organization |
| Authorized Contact | ANNA TODD Corporate Office & Project Manager 800-299-5161 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2020-01-08 |