| NPI | 1336203702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY JOHNSON Director 386-255-4568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251V00000X Voluntary or Charitable (Licence: FL OT424) |
| Additional Taxonomies | 251V00000X Voluntary or Charitable (Licence: FL OT 424) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2023-04-03 |