| NPI | 1174707640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLADYS FERNANDO Administrator 386-409-9456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL55) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2009-03-03 |