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General NPI Number Information
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NPI Number | 1457643843
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Entity Type | Organization
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Legal Business Name | EVA'S PLACE, LLC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 258 VESTRY RD
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City | PERKINSTON
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State | MS
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Zip | 39573-2901
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Country | US
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Telephone | 601-945-5053
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Fax |
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Provider Business Mailing Address
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Address Line | 4 HOLLY CV
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City | GULFPORT
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State | MS
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Zip | 39507-1945
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Country | US
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Telephone | 228-323-6365
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Fax | 228-897-4847
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JERRY HILL
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Credential |
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Telephone | 228-323-6365
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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 | 1041
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License Number State | MS
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