MEDICARE: THE VILLAGE ADULT DAYCARE, INC.

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	:	1992462196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VILLAGE ADULT DAYCARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1774
Second Line	:
City	:	YAZOO CITY
State	:	MS
Zip	:	39194-1774
Country	:	US
Telephone Number	:	662-998-2105
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 OLD BENTON RD
Second Line	:
City	:	YAZOO CITY
State	:	MS
Zip	:	39194-4663
Country	:	US
Telephone Number	:	662-998-2105
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. ASLEAN BROWN
Credential	:
Telephone Number	:	662-998-2105

Provider Enumeration Date	:	11/22/2021
Last Update Date	:	11/22/2021

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