| NPI | 1457669640 |
|---|---|
| Doing Business As | SOUTHERN TRACE REHABILITATION AND CARE CENTE |
| Entity Type | Organization |
| Authorized Contact | ROSS PONTHIE Member 318-443-8167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2020-07-13 |