Healthcare Provider Details

I. General information

NPI: 1669086591
Provider Name (Legal Business Name): JUSTLIKEHOME SUPPORTIVE LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 COUNTY ROAD 3312
ENTERPRISE MS
39330-9070
US

IV. Provider business mailing address

9 COUNTY ROAD 3312
ENTERPRISE MS
39330-9070
US

V. Phone/Fax

Practice location:
  • Phone: 601-214-6426
  • Fax:
Mailing address:
  • Phone: 601-214-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name: MISS BRITTANY N DAVIS
Title or Position: OWNER/MANAGER
Credential:
Phone: 601-214-6426