Healthcare Provider Details

I. General information

NPI: 1073990917
Provider Name (Legal Business Name): NORTH MISSISSIPPI ADULT DAY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 E SERVICE DR
COLDWATER MS
38618-3881
US

IV. Provider business mailing address

714 E SERVICE DR
COLDWATER MS
38618-3881
US

V. Phone/Fax

Practice location:
  • Phone: 662-622-0180
  • Fax: 662-622-0189
Mailing address:
  • Phone: 662-622-0180
  • Fax: 662-622-0189

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: MRS. OZELLA WARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 662-622-0180