| NPI | 1114386687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT BRADLEY WOODS Physical Therapy Assistant 601-278-8986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MS 4126) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-02-12 |