| NPI | 1689706574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM MULLINNIX CAO 318-221-2669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2020-08-22 |