| NPI | 1124479746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHEVON STALLWORTH CEO 407-461-7762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2016-06-24 |