Provider Demographics
NPI:1376893842
Name:IN LOVING ARMS LLC
Entity Type:Organization
Organization Name:IN LOVING ARMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVENE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:225-907-4117
Mailing Address - Street 1:6 SIEBENKITTEL CIRCLE STE B
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-8778
Mailing Address - Country:US
Mailing Address - Phone:225-907-4117
Mailing Address - Fax:601-510-9431
Practice Address - Street 1:83 WHITE CHAPEL ROAD
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-8778
Practice Address - Country:US
Practice Address - Phone:225-907-4117
Practice Address - Fax:601-510-9431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00003104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0000Medicaid