| NPI | 1225544208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIKI STAFFORD Administrator 904-233-1090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL11951) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2017-12-28 |