| NPI | 1588091458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI LYNN WATSON Nurse 662-563-9176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MS R745718) |
| Enumeration Date | 2013-10-08 |
| Last Update Date | 2013-10-08 |