| NPI | 1760852552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ICYLIN DOUGLAS Administrator 772-777-4463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL12708) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2015-10-06 |