| NPI | 1386628220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE MAYNARD Administrator 337-783-5533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2020-08-22 |