Provider Demographics
NPI:1679985212
Name:BOONEVILLE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:BOONEVILLE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-426-7851
Mailing Address - Street 1:1101 WEST CHAMBERS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALDWYN
Mailing Address - State:MS
Mailing Address - Zip Code:38824
Mailing Address - Country:US
Mailing Address - Phone:479-426-7851
Mailing Address - Fax:662-720-9594
Practice Address - Street 1:1101 W CHAMBERS DR
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-6840
Practice Address - Country:US
Practice Address - Phone:479-426-7851
Practice Address - Fax:662-720-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1024310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility