Healthcare Provider Details

I. General information

NPI: 1497182448
Provider Name (Legal Business Name): BURRAGE'S INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2013
Last Update Date: 10/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 HIGHLAND COLONY PKWY
RIDGELAND MS
39157-6035
US

IV. Provider business mailing address

PO BOX 16360
JACKSON MS
39236-6360
US

V. Phone/Fax

Practice location:
  • Phone: 601-991-0057
  • Fax:
Mailing address:
  • Phone:
  • 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: MARY LYON
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-720-6437