| NPI | 1104160027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THREASA HYSELL Executive Director 386-755-6560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL9472) |
| Additional Taxonomies | 311500000X Alzheimer Center (Dementia Center) (Licence: FL AL9472) |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL AL9472) | |
| 385H00000X Respite Care (Licence: FL AL9472) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |