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General NPI Number Information
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NPI Number | 1063530467
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Entity Type | Organization
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Legal Business Name | NORTHSIDE HAVEN ASSOCIATION, INC.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 50 PATTON PLACE RD
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City | LEXINGTON
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State | MS
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Zip | 39095-5851
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Country | US
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Telephone | 662-834-3344
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Fax | 662-834-3314
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Provider Business Mailing Address
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Address Line | 50 PATTON PLACE RD
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City | LEXINGTON
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State | MS
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Zip | 39095-5851
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Country | US
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Telephone | 662-834-3344
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Fax | 662-834-3314
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ZELPHA MONTGOMERY WHATLEY
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Credential |
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Telephone | 662-834-3344
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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 | 992
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License Number State | MS
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