| NPI | 1972902096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAVIS ERNESTINE HINSON Provider 772-460-8498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: FL 6906464) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2014-08-14 |