Organization
DESTINY MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAXINE D HARRIS (MANAGER)
(662) 378-7962
Entity
Organization
Contact information
Practice address
104 MARTIN LUTHER KING BLVD, ARCOLA, MS 38722
(662) 827-7500
(662) 827-7347
Mailing address
PO BOX 383, ARCOLA, MS 38722-0383
(662) 378-7962
(662) 827-7347
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
09/25/2019
Last updated
09/25/2019
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