| NPI | 1891170460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUDETTE JOHNSON Provider 813-513-4616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 311za0620x) |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2015-07-24 |