Healthcare Provider Details

I. General information

NPI: 1710352505
Provider Name (Legal Business Name): FAMILY FIRST PCS, LLC ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2015
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 1ST AVE NE
MAGEE MS
39111-3508
US

IV. Provider business mailing address

120 JACKSON RIDGE RD
CANTON MS
39046-9600
US

V. Phone/Fax

Practice location:
  • Phone: 662-571-4099
  • Fax:
Mailing address:
  • Phone: 662-571-4099
  • Fax:

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. HONDA CAPRI DORTCH
Title or Position: OWNER
Credential:
Phone: 662-571-4099