Organization
BOSWELL REGIONAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND JOHNSON (DIRECTOR)
(601) 867-5000
Entity
Organization
Contact information
Practice address
445 MAIN ST E, MEADVILLE, MS 39653-9293
(601) 384-1583
(601) 384-1585
Mailing address
PO BOX 128, MAGEE, MS 39111-0128
(601) 867-5000
(601) 849-2586
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
BOS-BMR
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015489
—
MS
Enumeration date
07/19/2006
Last updated
08/22/2020
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