| NPI | 1841772019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN RAYNARD SMITH Licensed Vocational Nurse 346-714-0798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 311Z00000X Custodial Care Facility | |
| 314000000X Skilled Nursing Facility | |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2018-09-04 |