| NPI | 1528481108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LASHANA MEDINA PORTER Administrator 904-930-7579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL12235) |
| Additional Taxonomies | 251E00000X Home Health |
| 261QA0600X Clinic/Center Adult Day Care | |
| 385H00000X Respite Care | |
| Enumeration Date | 2014-02-02 |
| Last Update Date | 2024-08-29 |