Provider Demographics
NPI:1790387462
Name:BOA VIDA HOSPITAL OF ABERDEEN, MS LLC
Entity Type:Organization
Organization Name:BOA VIDA HOSPITAL OF ABERDEEN, MS LLC
Other - Org Name:MRH MEDICAL GROUP, GSV HOULKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRNJOT
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-228-4355
Mailing Address - Street 1:10996 FOUR SEASONS PL STE 100C
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7762
Mailing Address - Country:US
Mailing Address - Phone:219-228-1021
Mailing Address - Fax:
Practice Address - Street 1:400 3RD AVENUE HWY 32 W
Practice Address - Street 2:
Practice Address - City:NEW HOULKA
Practice Address - State:MS
Practice Address - Zip Code:38850
Practice Address - Country:US
Practice Address - Phone:662-568-2013
Practice Address - Fax:662-568-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health