| NPI | 1619463007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MARIE CARLYLE Administrator 386-527-5918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL ALF13130) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2019-04-11 |