Organization
CLC OF BOONEVILLE, LLC
Active
Other names
Longwood Community Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS M. WRIGHT JR. (MANAGING MEMBER)
(662) 680-3148
Entity
Organization
Contact information
Practice address
200 LONG ST, BOONEVILLE, MS 38829-4306
(662) 728-6234
(662) 728-6944
Mailing address
200 LONG ST, BOONEVILLE, MS 38829-4306
(662) 728-6234
(662) 728-6944
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
155
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230175
—
MS
Enumeration date
10/25/2005
Last updated
01/28/2008
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