| NPI | 1982097572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN V. CLARK-MOREFIELD Manager 386-873-7407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 6906736) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2015-03-06 |