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General NPI Number Information
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NPI Number | 1316227580
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Entity Type | Organization
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Legal Business Name | SHIRLEY'S ASSISTED LIVING
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 1000 BB KING RD
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City | INDIANOLA
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State | MS
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Zip | 38751-3606
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Country | US
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Telephone | 662-887-3000
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Fax | 662-887-3500
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Provider Business Mailing Address
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Address Line | 1000 BB KING RD
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City | INDIANOLA
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State | MS
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Zip | 38751-3606
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Country | US
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Telephone | 662-887-3000
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Fax | 662-887-3500
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHIRLEY MONROE
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Credential |
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Telephone | 662-887-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 1014
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License Number State | MS
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