| NPI | 1366895195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA STEWART Owner 321-505-1770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: FL 6906872) |
| Enumeration Date | 2016-07-17 |
| Last Update Date | 2016-07-17 |