| NPI | 1205145034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN E THOMAS Residential Eldelry Administrator 877-702-4642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2010-09-28 |