| NPI | 1740268739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA C REARDON Administrator 318-428-3249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: LA 165) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2016-12-22 |