| NPI | 1346378387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARDIE O DIXON Administrator 601-924-2996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: MS 486) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: MS 486) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-22 |