Organization
HONEYSUCKLE VILLAGE SPECIALTY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE FORMAN (OWNER)
(601) 967-5358
Entity
Organization
Contact information
Practice address
5687 MEADVILLE RD, MEADVILLE, MS 39653-8535
(601) 967-5358
Mailing address
5687 MEADVILLE RD, MEADVILLE, MS 39653-8535
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
164W00000X
Licensed Practical Nurse
—
—
Other
Enumeration date
07/10/2026
Last updated
07/10/2026
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