Healthcare Provider Details

I. General information

NPI: 1124684766
Provider Name (Legal Business Name): PURE JOY MISSISSIPPI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2019
Last Update Date: 05/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DOVE WAY CIR
CLINTON MS
39056-3589
US

IV. Provider business mailing address

PO BOX 693
CLINTON MS
39060-0693
US

V. Phone/Fax

Practice location:
  • Phone: 601-966-5502
  • Fax:
Mailing address:
  • Phone: 601-966-5502
  • 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: JOSEPH LITTLE
Title or Position: CEO
Credential: MDIV
Phone: 601-966-5502