| NPI | 1811135718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE D. SMITH Family Nurse Practitioner 601-477-5770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: MS R865285) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2009-01-30 |