| NPI | 1023410545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENA OBRY Owner 863-229-5419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 6906588) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2014-09-17 |