| NPI | 1508241365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOVETTA LONG Owner 334-507-2368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: AL 607096) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2015-07-22 |