| NPI | 1174774657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL T BERG Secretary 505-468-4742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: VT 123) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2025-06-23 |