Provider Demographics
NPI:1669086591
Name:JUSTLIKEHOME SUPPORTIVE LIVING LLC
Entity type:Organization
Organization Name:JUSTLIKEHOME SUPPORTIVE LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-214-6426
Mailing Address - Street 1:9 COUNTY ROAD 3312
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:MS
Mailing Address - Zip Code:39330-9070
Mailing Address - Country:US
Mailing Address - Phone:601-214-6426
Mailing Address - Fax:
Practice Address - Street 1:9 COUNTY ROAD 3312
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:MS
Practice Address - Zip Code:39330-9070
Practice Address - Country:US
Practice Address - Phone:601-214-6426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty