| NPI | 1063634731 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IDA M. HARRIS Administrator 386-437-1373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL9204) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: FL AL9003) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |