# WOLTER ELSA H

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THE HACIENDA HOUSE LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639542582
- **Authorized official:** ELSA H WOLTER CNA (ADMINISTRATOR/OWNER)
- **Authorized official phone:** (352) 799-9943

## Contact information

- **Practice address:** 19390 POWELL RD, BROOKSVILLE, FL 34604-7057
- **Practice address phone:** (352) 799-9943
- **Mailing address:** 19390 POWELL RD, BROOKSVILLE, FL 34604-7057
- **Mailing address phone:** (352) 799-9943

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 6906810 | FL | Yes |

## Other

- **Enumeration date:** 11/01/2015
- **Last updated:** 11/01/2015