| NPI | 1750830485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CECILIA DAVIS Owner 386-292-4552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL 12673) |
| Additional Taxonomies | 385H00000X Respite Care (Licence: FL 12673) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2016-09-23 |