Healthcare Provider Details

I. General information

NPI: 1043239916
Provider Name (Legal Business Name): BOSWELL REGIONAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 MAIN ST E
MEADVILLE MS
39653-9293
US

IV. Provider business mailing address

PO BOX 128
MAGEE MS
39111-0128
US

V. Phone/Fax

Practice location:
  • Phone: 601-384-1583
  • Fax: 601-384-1585
Mailing address:
  • Phone: 601-867-5000
  • Fax: 601-849-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberBOS-BMR
License Number StateMS

VIII. Authorized Official

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