| NPI | 1013048453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STAN NORTHRIP Administrator 662-412-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: MS 667) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-08-22 |