MEDICARE: BOA VIDA HOSPITAL OF ABERDEEN, MS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1215419114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOA VIDA HOSPITAL OF ABERDEEN, MS LLC

Provider Business Mailing Address
First Line	:	10996 FOUR SEASONS PL STE 100A
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-8685
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	517 CENTER AVE N
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2552
Country	:	US
Telephone Number	:	601-656-1440
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIRNJOT SINGH
Credential	:
Telephone Number	:	888-339-7339

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	09/06/2018

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