Healthcare Provider Details

I. General information

NPI: 1649643578
Provider Name (Legal Business Name): REACHING OUR COMMUNITY YOUTH AND ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 E NORTHSIDE DR
CLINTON MS
39056-3467
US

IV. Provider business mailing address

469 E. NORTHSIDE DR 109 ANGELIA LANE
CLINTON MS
39056-3467
US

V. Phone/Fax

Practice location:
  • Phone: 601-488-4765
  • Fax: 601-488-4778
Mailing address:
  • Phone: 601-488-4765
  • Fax: 601-488-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRON BANKS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 601-624-4239