| NPI | 1316983810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERYL D JOHNSON Manager Of LLC 931-424-1456 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TN 177) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2015-09-30 |