| NPI | 1942340229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JO PARK Manager 731-925-4004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: TN 0000000120) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-08-22 |