| NPI | 1992406151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JATAN CLARK Owner 708-269-3891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2023-03-14 |