| NPI | 1871792804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE SANFORD Eo1 641-753-4315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IA I-00544) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2007-09-12 |