| NPI | 1356300206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HERVEY LAWRENCE Administrator 765-649-4558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3140N1450X Skilled Nursing Facility, Nursing Care, Pediatric |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2020-08-22 |