Provider Demographics
NPI:1942636998
Name:BUCKMAN ENRICHMENT HOME
Entity Type:Organization
Organization Name:BUCKMAN ENRICHMENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PARKE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-366-6920
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-0097
Mailing Address - Country:US
Mailing Address - Phone:662-562-0100
Mailing Address - Fax:
Practice Address - Street 1:3297 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2926
Practice Address - Country:US
Practice Address - Phone:662-562-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BADDOUR CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-23
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1074310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility