| NPI | 1285970012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA SMITH Executive Director 140-255-8022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: NE 111121) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: NE 111121) |
| 315D00000X Hospice, Inpatient (Licence: NE 111121) | |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2012-12-26 |