| NPI | 1174937700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUANITA MILLER Administrator 813-385-8188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 6906352) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-06-11 |