Healthcare Provider Details

I. General information

NPI: 1225211154
Provider Name (Legal Business Name): MCLIN , S ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TWELVE OAKS CIR
JACKSON MS
39209-6562
US

IV. Provider business mailing address

10 TWELVE OAKS CIR
JACKSON MS
39209-6562
US

V. Phone/Fax

Practice location:
  • Phone: 601-922-1769
  • Fax: 601-922-1769
Mailing address:
  • Phone: 601-922-1769
  • Fax: 601-922-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

Name: MRS. PAMELA VERNITA MCLIN
Title or Position: DIRECTOR
Credential:
Phone: 601-922-1769