| NPI | 1174511745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWNA LYNN MCMINN Medicare Manager 940-937-8668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: TX 110871) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2020-08-22 |