| NPI | 1003204322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADFORD MONTGOMERY Member 479-715-6759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: OK NH3803-3803) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2016-02-03 |