| NPI | 1609875160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED JIMINEZ Program Services Director 850-575-0619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: FL 4096096) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2020-08-22 |