Healthcare Provider Details

I. General information

NPI: 1861414781
Provider Name (Legal Business Name): BOSWELL REGIONAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 SIMPSON HIGHWAY 149 SOUTH
MAGEE MS
39111
US

IV. Provider business mailing address

PO BOX 128
MAGEE MS
39111-0128
US

V. Phone/Fax

Practice location:
  • Phone: 601-867-5000
  • Fax: 601-849-2586
Mailing address:
  • Phone: 601-867-5000
  • Fax: 601-849-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberBOS-BMR
License Number StateMS

VIII. Authorized Official

Name: MR. RAYMOND JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 601-867-5000