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Organization
MAJESTIC ESTATES LLC.
Active
Organization
MAJESTIC ESTATES LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHAREN NELSON (OWNER)
(601) 405-2116
Entity
Organization
Contact information
Practice address
511 N BROAD ST, FOREST, MS 39074-3511
(601) 405-2116
Mailing address
PO BOX 1442, FOREST, MS 39074-0442
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1029044
STATE ID
MS
Enumeration date
03/17/2014
Last updated
03/17/2014
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