Healthcare Provider Details

I. General information

NPI: 1043103849
Provider Name (Legal Business Name): REACH ADULT RECREATION SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E GHOLSON AVE
HOLLY SPRINGS MS
38635-3016
US

IV. Provider business mailing address

153 E GHOLSON AVE
HOLLY SPRINGS MS
38635-3016
US

V. Phone/Fax

Practice location:
  • Phone: 662-274-3049
  • Fax: 662-274-3081
Mailing address:
  • Phone: 662-274-3049
  • Fax: 662-274-3081

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. JOYCE SMITH BOWENS
Title or Position: C.E.O
Credential: L.P.N
Phone: 662-274-3049