| NPI | 1043679590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN COOKSEY Owner/CEO 800-342-6948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: FL JB29966) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-02-12 |