| NPI | 1164015301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LADONNA E JOHNSTON VP/Administrator 870-512-3022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC0050X Clinic/Center, Critical Access Hospital |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2021-02-18 |