| NPI | 1194500157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH HARRELSON Authorized Official 239-403-0402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM3000X Clinic/Center, Medically Fragile Infants and Children Day Care |
| Additional Taxonomies | 3140N1450X Skilled Nursing Facility, Nursing Care, Pediatric |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2024-06-28 |