Provider Demographics
NPI:1336507284
Name:LAPEARLS RESIDENTIAL AND PRIVATE CARE FACILITY
Entity Type:Organization
Organization Name:LAPEARLS RESIDENTIAL AND PRIVATE CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CONSWAYDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-373-4422
Mailing Address - Street 1:2634 E LAKE BLVD APT 9-9
Mailing Address - Street 2:
Mailing Address - City:ROBINSONVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38664-8916
Mailing Address - Country:US
Mailing Address - Phone:662-373-4422
Mailing Address - Fax:
Practice Address - Street 1:2634 E LAKE BLVD APT 9-9
Practice Address - Street 2:
Practice Address - City:ROBINSONVILLE
Practice Address - State:MS
Practice Address - Zip Code:38664-8916
Practice Address - Country:US
Practice Address - Phone:662-373-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities