| NPI | 1164476107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA M LALOR Director/Delegated Official 629-215-3953 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MS 12-023) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2021-04-22 |