Healthcare Provider Details

I. General information

NPI: 1881329092
Provider Name (Legal Business Name): ANNIE'S ANGELS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2683 HIGHWAY 15
BAY SPRINGS MS
39422-7431
US

IV. Provider business mailing address

PO BOX 593
BAY SPRINGS MS
39422-0593
US

V. Phone/Fax

Practice location:
  • Phone: 601-452-6406
  • Fax:
Mailing address:
  • Phone: 601-452-6406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE MAYS
Title or Position: CEO
Credential:
Phone: 601-670-0617