| NPI | 1598211682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE DAVIS WEATHERSPOON Owner/Operator 239-248-8167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 6906467) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2016-08-29 |