| NPI | 1194478941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY HEATHER CLEMENT Owner/Administrator 940-337-6777 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2022-02-01 |