Organization
SPRINGWOOD HEALTH & SUPPORTIVE LIVING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KEANNA ANTAJANI WINTERS (CHIEF EXECUTIVE OFFICER)
(662) 404-1908
Entity
Organization
Contact information
Practice address
6447 CHEYENNE DR, OLIVE BRANCH, MS 38654-5172
(662) 404-1908
Mailing address
6447 CHEYENNE DR, OLIVE BRANCH, MS 38654-5172
(662) 404-1908
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1908
—
TN
Enumeration date
02/14/2020
Last updated
02/14/2020
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