| NPI | 1497807119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA PARK Administrator 731-696-4541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: TN 0000000029) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-06-23 |