Healthcare Provider Details

I. General information

NPI: 1740531953
Provider Name (Legal Business Name): ANCHOR OF LOVE ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 RUCKER CIR
GREENWOOD MS
38930-7523
US

IV. Provider business mailing address

PO BOX 9884
GREENWOOD MS
38930-8484
US

V. Phone/Fax

Practice location:
  • Phone: 662-392-1902
  • Fax:
Mailing address:
  • Phone:
  • 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: JENNIFER ANDERSON
Title or Position: OWNER
Credential:
Phone: 662-392-1902