| NPI | 1760627640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN LEIGH BRADLEY Cert. Recreation Therapist 501-257-3469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: NY 22745) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: NY Cert. ID # 22745) |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2008-12-08 |