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General NPI Number Information
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NPI Number | 1679985212
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Entity Type | Organization
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Legal Business Name | BOONEVILLE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 1101 W CHAMBERS DR
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City | BOONEVILLE
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State | MS
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Zip | 38829-6840
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Country | US
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Telephone | 479-426-7851
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Fax | 662-720-9594
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Provider Business Mailing Address
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Address Line | 1101 WEST CHAMBERS DRIVE
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City | BALDWYN
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State | MS
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Zip | 38824
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Country | US
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Telephone | 479-426-7851
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Fax | 662-720-9594
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JESSICA ARNOLD
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Credential |
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Telephone | 479-426-7851
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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 | 1024
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License Number State | MS
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