| NPI | 1174941496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADFORD MONTGOMERY Member 479-250-5558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: OK NH4001-4001) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2024-06-07 |