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General NPI Number Information
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NPI Number | 1942636998
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Entity Type | Organization
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Legal Business Name | BUCKMAN ENRICHMENT HOME
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 3297 HIGHWAY 51 S
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City | SENATOBIA
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State | MS
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Zip | 38668-2926
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Country | US
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Telephone | 662-562-0100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 97
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City | SENATOBIA
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State | MS
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Zip | 38668-0097
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Country | US
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Telephone | 662-562-0100
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. PARKE DANIEL PEPPER
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Credential |
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Telephone | 662-366-6920
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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 | 1074
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License Number State | MS
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