| NPI | 1538143250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA L ELLIS Com PT Roller 601-304-0980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MS 624) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2007-07-27 |