MEDICARE: NEW VINEYARD COMMUNITY DEVELOPMENT CENTER

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

General Provider Information

NPI Number	:	1912877317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VINEYARD COMMUNITY DEVELOPMENT CENTER

Provider Business Mailing Address
First Line	:	3895 HENDERSON RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39272-4411
Country	:	US
Telephone Number	:	601-487-2330
Fax Number	:

Provider Business Practice Location Address
First Line	:	3895 HENDERSON RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39272-4411
Country	:	US
Telephone Number	:	601-487-2330
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LATANYA SANDERS-KELKER
Credential	:
Telephone Number	:	601-487-2330

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	11/10/2025

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