| NPI | 1477690857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN K BAGGERSON Bookkeeper 386-258-8789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: FL 676245096) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2008-07-08 |