| NPI | 1790119519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHINA DANETTE JOHNSON Owner/President 662-369-0070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MS 1016) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2013-08-28 |