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General NPI Number Information
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NPI Number | 1376893842
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Entity Type | Organization
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Legal Business Name | IN LOVING ARMS LLC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 83 WHITE CHAPEL ROAD
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City | CARRIERE
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State | MS
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Zip | 39426-8778
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Country | US
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Telephone | 225-907-4117
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Fax | 601-510-9431
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Provider Business Mailing Address
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Address Line | 6 SIEBENKITTEL CIRCLE STE B
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City | CARRIERE
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State | MS
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Zip | 39426-8778
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Country | US
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Telephone | 225-907-4117
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Fax | 601-510-9431
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | DR. MARVENE AUGUSTUS
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Credential | PHARM.D.
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Telephone | 225-907-4117
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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 | 0000
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License Number State | MS
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