Organization
DOUGLAS ASSISTED LIVING FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ALYCE CARTER (OWNER/ADMINISTRATOR)
(386) 755-3304
Entity
Organization
Contact information
Practice address
769 NE GURLEY AVE, LAKE CITY, FL 32055-2453
(386) 755-3304
Mailing address
769 NE GURLEY AVE, LAKE CITY, FL 32055-2453
(386) 755-3304
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL7558
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1402340
—
FL
Enumeration date
05/08/2013
Last updated
05/08/2013
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