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General NPI Number Information
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NPI Number | 1851155394
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Entity Type | Organization
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Legal Business Name | GREENVILLE ASSISTED LIVING
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Dates
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Enumeration Date | 02/06/2024
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 1880 FAIRGROUND ROAD
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City | GREENVILLE
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State | MS
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Zip | 38703
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Country | US
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Telephone | 662-334-4646
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Fax | 662-334-4691
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Provider Business Mailing Address
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Address Line | 1880 FAIRGROUND ROAD
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City | GREENVILLE
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State | MS
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Zip | 38703
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Country | US
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Telephone | 662-334-4646
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Fax | 662-334-4691
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Authorized Official
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Title or Position | SOLE OWNER
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Name | JAMES MURRY REAGOR
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Credential |
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Telephone | 662-334-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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