| NPI | 1215315528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUNENA IRENE STAPLE Pca 601-942-9401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MS Domo5355) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2015-05-07 |