| NPI | 1619361557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMIKA COLEMAN Healthcare Provider 870-639-3891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2015-03-27 |