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General NPI Number Information
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NPI Number | 1013283688
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Entity Type | Organization
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Legal Business Name | PORT CITY ADULT DAYCARE
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1255 S RACEWAY RD
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City | GREENVILLE
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State | MS
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Zip | 38703-8208
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Country | US
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Telephone | 662-701-5856
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Fax | 662-796-0611
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Provider Business Mailing Address
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Address Line | PO BOX 5453
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City | GREENVILLE
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State | MS
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Zip | 38704-5453
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Country | US
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Telephone | 662-701-5856
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Fax | 662-796-0611
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Authorized Official
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Title or Position | OWNER
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Name | MS. BETTIE JO PRUITT
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Credential |
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Telephone | 662-701-5856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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