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General NPI Number Information
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NPI Number | 1013366012
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Entity Type | Organization
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Legal Business Name | COOKS ADULT DAY CARE LLC
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 611 MOSS HILL DR
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City | NEW ALBANY
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State | MS
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Zip | 38652
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 135 W BANKHEAD ST
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City | NEW ALBANY
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State | MS
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Zip | 38652-3314
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Country | US
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Telephone | 662-534-6789
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Fax | 662-534-4405
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CALRENEASE COOK
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Credential | LPN
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Telephone | 662-534-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State | MS
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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