| NPI | 1972861185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA JEAN JOHNSON Administrator 904-249-4673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 9035) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2012-04-25 |