NPI | 1780659599 |
---|---|
Entity Type | Organization |
Authorized Contact | BRANDON VERROS 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) |
332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: IA 750085) | |
Enumeration Date | 2006-02-23 |
Last Update Date | 2015-03-04 |