| NPI | 1598138968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN O AGOGO Ota 682-234-5690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TX 224Z00000X) |
| Enumeration Date | 2015-11-07 |
| Last Update Date | 2015-11-07 |