| NPI | 1912384157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELYNE SHAW Speech Language Pathologist 254-715-5328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2015-04-27 |