| NPI | 1053589739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE MEDELON Administrator 321-722-9442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: FL 6906143) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-02-14 |