| NPI | 1972249993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE ANTOINETTE ALEXIS Administrator 386-338-7974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2022-05-16 |