| NPI | 1285861591 |
|---|---|
| Doing Business As | JERALD MACK SR |
| Entity Type | Organization |
| Authorized Contact | JERALD MACK Owner / CEO 813-965-6914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 6906334) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2009-06-12 |