| NPI | 1760994511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOPHIA L BURTON Owner 386-338-1978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2024-10-11 |