| NPI | 1992518526 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | FIDELE NDABUNGUYE Licensee 208-957-1870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2025-01-28 |
| Last Update Date | 2025-01-28 |