| NPI | 1952673162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONIESHA DAVIS Speech Language Pathologist 662-291-0031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TN 4282) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2012-02-02 |