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General NPI Number Information
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NPI Number | 1609164912
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Entity Type | Organization
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Legal Business Name | THERAPYWORKS
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 5 BRIANLEIGH DR
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City | LAUREL
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State | MS
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Zip | 39443-5798
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Country | US
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Telephone | 601-467-3476
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4252
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City | LAUREL
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State | MS
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Zip | 39441-4252
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Country | US
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Telephone | 601-467-3476
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. SHANNON LANE BROWN
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Credential | COTA
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Telephone | 601-467-3476
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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 | TA2354
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License Number State | MS
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