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General NPI Number Information
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NPI Number | 1336507284
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Entity Type | Organization
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Legal Business Name | LAPEARLS RESIDENTIAL AND PRIVATE CARE FACILITY
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Dates
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Enumeration Date | 02/07/2016
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Last Update Date | 02/07/2016
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Provider Practice Location Address
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Address Line | 2634 E LAKE BLVD APT 9-9
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City | ROBINSONVILLE
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State | MS
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Zip | 38664-8916
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Country | US
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Telephone | 662-373-4422
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Fax |
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Provider Business Mailing Address
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Address Line | 2634 E LAKE BLVD APT 9-9
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City | ROBINSONVILLE
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State | MS
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Zip | 38664-8916
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Country | US
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Telephone | 662-373-4422
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MISS CONSWAYDA L MERRITT
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Credential |
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Telephone | 662-373-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | MS
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