Healthcare Provider Details

I. General information

NPI: 1629904495
Provider Name (Legal Business Name): CONFIDENT LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6521 BLUE BIRD LN
OLIVE BRANCH MS
38654-9624
US

IV. Provider business mailing address

6521 BLUE BIRD LN
OLIVE BRANCH MS
38654-9624
US

V. Phone/Fax

Practice location:
  • Phone: 601-291-7587
  • Fax:
Mailing address:
  • Phone: 601-291-7587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KEVIN SMITH
Title or Position: OWNER
Credential: OT
Phone: 601-291-7587