| NPI | 1881093714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WISLY NOEL Owner 904-554-6051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 6906679) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2014-08-15 |