| NPI | 1023213816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY E EDWARDS Office Manager 800-978-0019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: TN L 438-096-1526) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2020-08-22 |