Organization
WOLTER ELSA H
Active
Other names
THE HACIENDA HOUSE LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ELSA H WOLTER CNA (ADMINISTRATOR/OWNER)
(352) 799-9943
Entity
Organization
Contact information
Practice address
19390 POWELL RD, BROOKSVILLE, FL 34604-7057
(352) 799-9943
Mailing address
19390 POWELL RD, BROOKSVILLE, FL 34604-7057
(352) 799-9943
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906810
FL
Other
Enumeration date
11/01/2015
Last updated
11/01/2015
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