| NPI | 1255866059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE ELIZABETH MILLSAP Owner 601-323-7433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: MS R733788) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MS R733788) |
| Enumeration Date | 2017-04-29 |
| Last Update Date | 2017-04-29 |