| NPI | 1417259300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE S EVERETT Provider 863-773-3700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 6906219) |
| Enumeration Date | 2010-11-26 |
| Last Update Date | 2010-11-26 |