| NPI | 1528481108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LASHANA MEDINA PORTER Administrator 904-349-1420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL12235) |
| Enumeration Date | 2014-02-02 |
| Last Update Date | 2014-02-02 |