| NPI | 1265416986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA L ELLIS Com PT Roller 601-304-0980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MS 80) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2020-08-22 |