| NPI | 1255658365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILO DFERIVAL Cna 813-410-7719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL CNA27905) |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: FL CNA27905) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2010-04-28 |