| NPI | 1114340155 |
|---|---|
| Doing Business As | DIXIE LODGE |
| Entity Type | Organization |
| Authorized Contact | JACEK DYGDON Owner 386-734-4830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: FL AL1077) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-01-28 |