Healthcare Provider Details

I. General information

NPI: 1841715539
Provider Name (Legal Business Name): HAPPICARE ONE LLC PPEC PEDIATRIC DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W PARK AVE
GREENWOOD MS
38930-3008
US

IV. Provider business mailing address

213 W PARK AVE
GREENWOOD MS
38930-3008
US

V. Phone/Fax

Practice location:
  • Phone: 662-299-9385
  • Fax:
Mailing address:
  • Phone: 662-374-5028
  • Fax: 662-374-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: HOPE ELIZABETH WILLIAMS
Title or Position: INTERIM ADMINISTRATOR
Credential: NP
Phone: 662-374-5028