| NPI | 1104010495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE M STROTHER Lpn 772-807-9084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: FL PN5166432) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2007-08-30 |