| NPI | 1982999090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GOLD OMEREONYE Owner 414-975-0121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: WI 126208-30) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2011-06-16 |