| NPI | 1629274550 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | MARY O. BURROUGHS Nha #646 912-398-3254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 332BN1400X Durable Medical Equipment & Medical Supplies Nursing Facility Supplies |
| 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2009-06-19 |