| NPI | 1790805018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIFI JACOB Manager 618-628-7671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MO 037135) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: MO 031347) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2009-08-03 |