| NPI | 1023463429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALIA M JACKSON RODRIGUEZ Owner 239-207-0948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME 104632) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: FL ME 104632) |
| 314000000X Skilled Nursing Facility (Licence: FL ME 104632) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2016-05-04 |