| NPI | 1417944265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINDI RENAE BAKER Administrator 712-263-3114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: IA 0890475) |
| 313M00000X Nursing Facility/Intermediate Care Facility | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2013-10-17 |