| NPI | 1154622686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI SULLIVAN Owner 352-669-3637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 684526696) |
| Enumeration Date | 2010-11-15 |
| Last Update Date | 2010-11-15 |