| NPI | 1356765101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH R VAUGHN Administrator 662-326-4797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2014-02-14 |
| Last Update Date | 2014-02-14 |