| NPI | 1124302617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMLAWATY LAKRAM Administrator 772-595-5565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: FL AL9025) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-04 |