| NPI | 1972901130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN D HOLZ Owner 509-846-0146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WA 597900) |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2014-12-19 |