| NPI | 1164852968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS K MITTLDEIDER President 770-619-0866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TN 1000000013271) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2013-11-15 |