Organization
METHODIST HOME ROAD ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIARA LASHAE JOHNSON (MANAGER)
(601) 918-6415
Entity
Organization
Contact information
Practice address
4560 METHODIST HOME RD, JACKSON, MS 39213-4201
(769) 257-7232
(769) 257-7745
Mailing address
4560 METHODIST HOME RD, JACKSON, MS 39213-4201
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
06/19/2014
Last updated
06/19/2014
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