Healthcare Provider Details

I. General information

NPI: 1912521485
Provider Name (Legal Business Name): RN VA DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E SOUTH ST
HOLLANDALE MS
38748-3834
US

IV. Provider business mailing address

PO BOX 231
HOLLANDALE MS
38748-0231
US

V. Phone/Fax

Practice location:
  • Phone: 662-827-5755
  • Fax: 662-827-5766
Mailing address:
  • Phone: 662-827-5755
  • Fax: 662-827-5766

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: SENTHAN HARRIS
Title or Position: CEO
Credential:
Phone: 662-379-5557