| NPI | 1609184753 |
|---|---|
| Doing Business As | SHADY GROVE CENTER |
| Entity Type | Organization |
| Authorized Contact | MICHAEL T. BERG Assistant Secretary 505-468-4752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MD 15009) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2016-01-08 |