Healthcare Provider Details

I. General information

NPI: 1811134778
Provider Name (Legal Business Name): MOUNT ZION ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 FRED MARTIN RD
SUMMIT MS
39666-8019
US

IV. Provider business mailing address

4027 FRED MARTIN RD
SUMMIT MS
39666-8019
US

V. Phone/Fax

Practice location:
  • Phone: 601-249-1999
  • Fax:
Mailing address:
  • Phone: 601-249-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. BENTON THOMPSON
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 601-249-1999