| NPI | 1699036285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES HAM Manager 386-562-0870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL 10293) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: FL al10293) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2014-10-27 |