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General NPI Number Information
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NPI Number | 1508991357
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Entity Type | Organization
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Legal Business Name | SAMARITAN GARDEN PERSONAL CARE HOME
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 2603 S GLOSTER ST
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City | TUPELO
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State | MS
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Zip | 38801-6903
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Country | US
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Telephone | 662-566-9974
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Fax |
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Provider Business Mailing Address
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Address Line | 2603 S GLOSTER ST
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City | TUPELO
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State | MS
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Zip | 38801-6903
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Country | US
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Telephone | 662-566-9974
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LISA PULLIAM SATTERWHITE
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Credential |
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Telephone | 662-566-9974
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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 | 876
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License Number State | MS
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