Healthcare Provider Details

I. General information

NPI: 1083088835
Provider Name (Legal Business Name): GOLDEN LADIES & GENTLEMEN ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 W NORTHSIDE DR
JACKSON MS
39206-4636
US

IV. Provider business mailing address

PO BOX 350
CANTON MS
39046-0350
US

V. Phone/Fax

Practice location:
  • Phone: 601-942-1098
  • Fax:
Mailing address:
  • Phone: 601-942-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateMS

VIII. Authorized Official

Name: MRS. DENA S BENSON
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 601-942-1098