| Organization Name: | BENTON COUNTY COMMISSION ON AGING AND INDEPENDEN LIVING |
| NPI Number: | 1104216324 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARL LATRON ROBINSON (OWNER) |
| Mailing Address: | 1342 Country Church Rd Lamar |
| State: | MS US |
| Postal Code: | 38642 |
| Phone Number: | 9494419900 |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2015 |
| NPI Last Update Date: | 02/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA0600X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Day Care |
| Taxonomy Definition: | |