Provider Demographics
NPI:1316227580
Name:SHIRLEY'S ASSISTED LIVING
Entity Type:Organization
Organization Name:SHIRLEY'S ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-887-3000
Mailing Address - Street 1:1000 BB KING RD
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-3606
Mailing Address - Country:US
Mailing Address - Phone:662-887-3000
Mailing Address - Fax:662-887-3500
Practice Address - Street 1:1000 BB KING RD
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-3606
Practice Address - Country:US
Practice Address - Phone:662-887-3000
Practice Address - Fax:662-887-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10143104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness