| NPI | 1235314915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERRY KAY HALLBACK Program Coordinator 813-650-8242 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: FL AL11825) |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 692691696) | |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2020-01-09 |