Healthcare Provider Details

I. General information

NPI: 1790272185
Provider Name (Legal Business Name): BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 01/24/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 MS-178 SUITE 2
SHERMAN MS
38869
US

IV. Provider business mailing address

10996 FOUR SEASONS PL STE 100C
CROWN POINT IN
46307-7762
US

V. Phone/Fax

Practice location:
  • Phone: 662-269-2151
  • Fax:
Mailing address:
  • Phone: 219-228-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KIRNJOT SINGH
Title or Position: PRESIDENT
Credential: MD
Phone: 219-228-4355