| NPI | 1821679812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUBREY MONTGOMERY Member 479-236-9507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-04-20 |