| NPI | 1790516821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVIDSON AUGUSTIN Mgr/ Administrator 904-616-7903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Enumeration Date | 2024-08-10 |
| Last Update Date | 2025-09-09 |