| NPI | 1821081977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LAKE DEGRAND Administrator 254-559-3386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TX 004773) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2020-08-22 |