| NPI | 1922307586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL M DOMISIW Owner/Administrator 863-382-2116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL4947) |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: FL AL4947) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2011-03-22 |