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General NPI Number Information
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NPI Number | 1023519766
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Entity Type | Organization
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Legal Business Name | THE BLAKE AT OXFORD
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 110 ED PERRY BLVD
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City | OXFORD
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State | MS
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Zip | 38655-3452
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Country | US
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Telephone | 662-234-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 110 ED PERRY BLVD
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City | OXFORD
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State | MS
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Zip | 38655-3452
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Country | US
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Telephone | 662-234-5050
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Fax |
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Authorized Official
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Title or Position | REGIONAL DIRECTOR OF OPERATIONS
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Name | PERIAN PETCHER
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Credential |
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Telephone | 980-275-0974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 1204
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License Number State |
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