Organization
INDYWOOD ESTATE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHARON HARVEY (ASSISTANT MANAGER)
(662) 455-3878
Entity
Organization
Contact information
Practice address
218 RONALDMAN RD, CLEVELAND, MS 38732-8755
(662) 843-7885
(662) 843-7985
Mailing address
1416 ERIE ST, GREENWOOD, MS 38930-2103
(662) 455-3878
(662) 455-6171
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
960
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00037512
—
MS
Enumeration date
09/07/2012
Last updated
09/07/2012
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