| NPI | 1275941833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN MALDONADO Administrator 904-743-9069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: FL AL8958) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2014-07-28 |