| NPI | 1396102554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY FAISON President 863-670-7840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL RN2684312) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2016-01-19 |