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General NPI Number Information
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NPI Number | 1932909421
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Entity Type | Organization
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Legal Business Name | EMERITRACE LLC
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 501 E NORTHSIDE DR
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City | CLINTON
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State | MS
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Zip | 39056-3604
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Country | US
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Telephone | 601-926-1224
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Fax |
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Provider Business Mailing Address
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Address Line | 501 E NORTHSIDE DR
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City | CLINTON
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State | MS
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Zip | 39056-3604
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Country | US
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Telephone | 601-926-1224
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | ANNA F.C. MUNOZ
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Credential |
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Telephone | 414-918-5443
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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 |
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License Number State |
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