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| Id No | 12342 |
| Registration | Licensed |
| Bedrooms | 0 |
| Bathrooms | 0 |
| License Date | 2020-03-26 |
| Inspection Visit Count | 2 |
| Complaint Visit | 0 |
| Created | 2 years ago |
| Bedridden Waiver | No |
| Facility Type | Board and Care |
| Facility No | 197609890 |
| Capacity | 6 |
| Area | 0 sqft |
| Inspection Last Visit | February 16, 2023 |
| Other Visit Count | 1 |
| Views | 17 |
| Hospice Waiver | 0 |