| NPI | 1841639929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEESHA MONAIE SULLIVAN Owner 727-692-7364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL SW 11227) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2013-07-09 |