Organization
PERSONAL CARE HOME OF WIGGINS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA C HARRIS (OWNER/ADMINISTRATOR)
(601) 325-4577
Entity
Organization
Contact information
Practice address
918 PARKWAY DR, WIGGINS, MS 39577-8750
(601) 928-4663
(601) 928-4668
Mailing address
918 PARKWAY DR, WIGGINS, MS 39577-8750
(601) 928-4663
(601) 928-4668
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
1038
MS
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
1038
MS
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
1038
MS
Other
Enumeration date
08/30/2010
Last updated
08/30/2010
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