| NPI | 1710085626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONARD B WORCESTER Administrator 712-629-2645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: IA 360577) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-08-22 |