Healthcare Provider Details

I. General information

NPI: 1619597960
Provider Name (Legal Business Name): AMAZING ADULT DAYCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 MAIN ST
PLANTERSVILLE MS
38862-5002
US

IV. Provider business mailing address

2484 MAIN ST
PLANTERSVILLE MS
38862-5002
US

V. Phone/Fax

Practice location:
  • Phone: 662-205-4597
  • Fax:
Mailing address:
  • Phone: 662-205-4597
  • 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: VANESSA YOUNG
Title or Position: OWNER
Credential:
Phone: 662-322-9687