| NPI | 1013109479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA ELLIS Com PT Roller 601-304-0980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MS 179) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2007-08-09 |