| NPI | 1780659599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA NETLEY Provisional Administrator 712-568-2422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IA 750085) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IA I153) |
| 314000000X Skilled Nursing Facility | |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: IA 750085) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2025-07-15 |