| NPI | 1043671704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS MONTEZ DELOACH Owner 601-310-8014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 3104A0630X Assisted Living Facility Assisted Living, Behavioral Disturbances |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2016-03-09 |