Provider Demographics
NPI:1104574300
Name:MERIDIAN LIVING, LLC
Entity type:Organization
Organization Name:MERIDIAN LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-918-7733
Mailing Address - Street 1:538 BONITA LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-6992
Mailing Address - Country:US
Mailing Address - Phone:601-512-0512
Mailing Address - Fax:601-693-3350
Practice Address - Street 1:538 BONITA LAKES DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-6992
Practice Address - Country:US
Practice Address - Phone:601-512-0512
Practice Address - Fax:601-693-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1242OtherDEPARTMENT OF HEALTH