| NPI | 1588650618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE M TRAVIS Asst Business Admn 270-395-4124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2020-08-22 |