| NPI | 1649389610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY M. AVERETT Administrator 334-347-9541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: AL N1602) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL N1602) |
| 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: AL N1602) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-04-17 |