| NPI | 1578697751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOM REDDICK Administrator 731-885-9065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: TN 0000000196) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: 4445508) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2018-02-13 |