| NPI | 1073763074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE ELAINE BUCK Administrator 386-313-3359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL11247) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2008-09-25 |