| NPI | 1457800708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN FAYE BENTLEY Provider/Owner 904-613-2234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2016-09-28 |