| NPI | 1295084325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY FISHER Executive Director 662-466-0544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2012-09-05 |