Healthcare Provider Details

I. General information

NPI: 1063756591
Provider Name (Legal Business Name): CHARITY BEGINS AT HOME ADULT DAY SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 E MAIN ST
MARKS MS
38646-1317
US

IV. Provider business mailing address

PO BOX 1062
CLARKSDALE MS
38614-1062
US

V. Phone/Fax

Practice location:
  • Phone: 662-313-7180
  • Fax:
Mailing address:
  • Phone: 662-313-7180
  • Fax:

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: SHAKIDA P GOODEN
Title or Position: CEO/ADMINISTRATIVE ASST
Credential:
Phone: 662-313-7180