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General NPI Number Information
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NPI Number | 1831556331
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Entity Type | Organization
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Legal Business Name | FALCON CREST PERSONAL CARE ASSISTED LIVING
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 4 FALCON LN
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City | HATTIESBURG
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State | MS
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Zip | 39401-9350
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Country | US
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Telephone | 601-336-4590
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Fax | 601-336-4598
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Provider Business Mailing Address
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Address Line | 4 FALCON LN
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City | HATTIESBURG
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State | MS
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Zip | 39401-9350
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Country | US
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Telephone | 601-336-4590
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Fax | 601-336-4598
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SUSAN M PARKER
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Credential | RN
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Telephone | 601-336-4590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 1092
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License Number State | MS
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