Organization
THE COVINGTON'S COVE ASSISTED LIVING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS MONTEZ DELOACH RN (OWNER)
(601) 310-8014
Entity
Organization
Contact information
Practice address
192 MARY MAGDALENE CHURCH RD, HATTIESBURG, MS 39401
(601) 310-8014
Mailing address
510 MAPLE DR, PETAL, MS 39465-6816
(601) 310-8014
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
03/09/2016
Last updated
03/09/2016
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