| NPI | 1083256515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH CLAY FOWLER Manager 770-500-2705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2019-10-16 |