| NPI | 1013634054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHINA JOHNSON Administrator 662-369-0070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Additional Taxonomies | 251J00000X Nursing Care |
| 310400000X Assisted Living Facility | |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| 385H00000X Respite Care | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-20 |