| NPI | 1043569809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA CANNON Doa 318-453-4060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: TN 4577) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2012-09-07 |