| NPI | 1982304796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARIKO MEKVABISHVILI President 414-745-3146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-03-09 |