| NPI | 1548520356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRICIE E FREEMAN Cota 321-945-0713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: FL ota9873) |
| Enumeration Date | 2012-05-26 |
| Last Update Date | 2012-05-26 |