| NPI | 1164880548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY C. ROUSSEAU Owner 863-738-8538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH13024) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2016-02-01 |