| NPI | 1962760108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOREEN O. EGAN Controller 863-465-6584 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL11307) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2012-04-25 |