| NPI | 1700128428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNATHAUN LEE Owner 954-479-9856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 310500000X Intermediate Care Facility, Mental Illness |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2013-03-20 |