| NPI | 1902953813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY MCNELLIS Owner 612-991-9062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: AZ NCI263) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: AZ ALC4564) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-09-08 |