| NPI | 1841332855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY PARK Administrator 731-692-4545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: TN 351) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: TN 351) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-06-23 |