| NPI | 1972135838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JHIENELLE TALETHIA KISTLE Executive Director 920-397-1610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Enumeration Date | 2020-02-09 |
| Last Update Date | 2020-02-09 |