Organization
ROSEWOOD RESIDENCE LLC
Active
Organization
ROSEWOOD RESIDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES L BOATNER JR. (OWNER)
(662) 842-8400
Entity
Organization
Contact information
Practice address
2441 MCCULLOUGH BLVD, BELDEN, MS 38826-9742
(662) 844-5856
(662) 680-4700
Mailing address
2441 MCCULLOUGH BLVD, BELDEN, MS 38826-9742
(662) 844-5856
(662) 680-4700
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
802
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770558
—
MS
Enumeration date
02/16/2007
Last updated
08/22/2020
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