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Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTINA ROSE CARLOUGH (OWNER)
(386) 307-2407
Entity
Organization

Contact information

Practice address
36 BRONSON LN, PALM COAST, FL 32137-8725
(386) 307-2407
(386) 302-0289
Mailing address
36 BRONSON LN, PALM COAST, FL 32137-8725
(386) 307-2407
(386) 302-0289

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104990100
FL
Enumeration date
03/10/2020
Last updated
03/25/2020
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