| NPI | 1114549763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON LAVERNE BENNETT Owner 229-200-4887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2020-05-16 |
| Last Update Date | 2021-10-12 |