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General NPI Number Information
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NPI Number | 1184289894
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER'S MANOR ASSISTED LIVING, INC.
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 885 HIGHWAY 178 E
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City | HOLLY SPRINGS
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State | MS
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Zip | 38635-2641
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Country | US
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Telephone | 662-551-1122
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4150
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City | TUPELO
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State | MS
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Zip | 38803-4150
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Country | US
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Telephone | 662-401-8930
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Fax | 662-401-8930
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH LONG
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Credential |
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Telephone | 662-401-8930
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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 |
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License Number State |
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