| NPI | 1699216309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD ANDRES MOGOLLON Owner 786-536-2896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL12047) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2023-04-19 |