| NPI | 1720073448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABATHA WATKINS Administrator 662-453-6323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: MS 46) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2022-01-20 |