MEDICARE: SOUTHERN COMMUNITY ADULT DAYCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912041849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN COMMUNITY ADULT DAYCARE

Provider Business Mailing Address
First Line	:	1011 IBERVILLE DR
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-2919
Country	:	US
Telephone Number	:	228-875-5123
Fax Number	:	888-304-0019

Provider Business Practice Location Address
First Line	:	1011 IBERVILLE DR
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-2919
Country	:	US
Telephone Number	:	228-875-5123
Fax Number	:	888-304-0019

Authorized Official
Title or Position	:	DIRECTOR OWNER
Name	:	MRS. SONYA LYNETTE RAMSEY
Credential	:	REGISTERED NURSE
Telephone Number	:	228-875-5123

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/22/2020

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Directions to “SOUTHERN COMMUNITY ADULT DAYCARE ” Practice Location

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