| NPI | 1083311757 |
|---|---|
| Former Legal Business Name | CITRUS CREST CARE HOME 1 LLC |
| Entity Type | Organization |
| Authorized Contact | MARIAM GBATY SOUMAHORO CEO 510-409-7096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2023-02-13 |