| NPI | 1689662488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE MARK DESHOTELS President Member 870-773-2376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TX 113456) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2008-06-24 |