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General NPI Number Information
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NPI Number | 1386950145
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Entity Type | Organization
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Legal Business Name | PERSONAL CARE HOME OF WIGGINS
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 918 PARKWAY DR
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City | WIGGINS
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State | MS
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Zip | 39577-8750
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Country | US
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Telephone | 601-928-4663
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Fax | 601-928-4668
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Provider Business Mailing Address
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Address Line | 918 PARKWAY DR
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City | WIGGINS
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State | MS
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Zip | 39577-8750
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Country | US
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Telephone | 601-928-4663
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Fax | 601-928-4668
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | ANGELA C HARRIS
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Credential |
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Telephone | 601-325-4577
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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 | 1038
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | 1038
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 1038
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License Number State | MS
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