Provider Demographics
NPI:1760728265
Name:SCOTT-DEL COTTAGE
Entity Type:Organization
Organization Name:SCOTT-DEL COTTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DIRLEY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-720-9593
Mailing Address - Street 1:1101 W CHAMBERS DR
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-6840
Mailing Address - Country:US
Mailing Address - Phone:662-720-9593
Mailing Address - Fax:662-720-9594
Practice Address - Street 1:1101 W CHAMBERS DR
Practice Address - Street 2:BOONEVILLE
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-6840
Practice Address - Country:US
Practice Address - Phone:662-720-9593
Practice Address - Fax:662-720-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility