Healthcare Provider Details

I. General information

NPI: 1285179705
Provider Name (Legal Business Name): C&K ADULT RECREATIONAL AND HOMECARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 GREEN AVENUE
DREW MS
38737-0314
US

IV. Provider business mailing address

PO BOX 314
DREW MS
38737-0314
US

V. Phone/Fax

Practice location:
  • Phone: 662-482-5067
  • Fax: 662-482-5076
Mailing address:
  • Phone: 662-482-5067
  • Fax: 662-482-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TISHIKA PRICE
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 662-482-5067