| NPI | 1679554018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLY LYNN WALLACE Mds / Pps Nurse 979-542-1755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TX 108720) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2020-08-22 |