Healthcare Provider Details

I. General information

NPI: 1336507284
Provider Name (Legal Business Name): LAPEARLS RESIDENTIAL AND PRIVATE CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2016
Last Update Date: 02/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 E LAKE BLVD APT 9-9
ROBINSONVILLE MS
38664-8916
US

IV. Provider business mailing address

2634 E LAKE BLVD APT 9-9
ROBINSONVILLE MS
38664-8916
US

V. Phone/Fax

Practice location:
  • Phone: 662-373-4422
  • Fax:
Mailing address:
  • Phone: 662-373-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateMS

VIII. Authorized Official

Name: MISS CONSWAYDA L MERRITT
Title or Position: OWNER/OPERATOR
Credential:
Phone: 662-373-4422