| NPI | 1114900099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEWANA LITTLE Administrator 318-428-9612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: LA 467) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2011-04-11 |