| NPI | 1356374367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS K MITTLEIDER President 770-619-0866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: WI 2578) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-08-22 |