| NPI | 1427643667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KASEY ROSS Administrator 352-219-2262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 251B00000X Case Management | |
| 251S00000X Community/Behavioral Health | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2023-02-03 |