| NPI | 1386005841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELINDA CATHERINE JOHNSON Owner 863-255-9370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2016-03-11 |