| Name | Value |
|---|---|
| PROVIDER TYPE | Nursing & Custodial Care Facilities |
| CLASSIFICATION | Custodial Care Facility |
| DEFINITION | A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| AREA OF SPECIALIZATION | Adult Care Home |
| STATUS | Active |
| X12 CODE | 311ZA0620X |
| INDIVIDUAL/NON | NON-INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252765 |
| EFFECTIVE DATE/TIME |
|