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NPI 1033350632

NPI 1033350632 : UNLIMITED DREAMS II : LAUREL, MS

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General NPI Number Information
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    NPI Number           |    1033350632
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    Entity Type          |    Organization 
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    Legal Business Name  |    UNLIMITED DREAMS II 
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Dates
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    Enumeration Date     |    03/12/2009
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    Last Update Date     |    03/12/2009
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Provider Practice Location Address
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    Address Line         |    3115 AUDUBON DR 
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    City                 |    LAUREL
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    State                |    MS
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    Zip                  |    39440-1913
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    Country              |    US
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    Telephone            |    601-425-4888
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    3115 AUDUBON DR 
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    City                 |    LAUREL
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    State                |    MS
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    Zip                  |    39440-1913
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    Country              |    US
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    Telephone            |    601-425-4888
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    Fax                  |    
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Authorized Official
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    Title or Position    |    OWNER/ADMINISTRATOR
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    Name                 |    MRS. AMANDA CHARAY JENKINS 
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    Credential           |    
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    Telephone            |    601-425-4888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    251G00000X
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    Taxonomy Name        |    Community Based Hospice Care Agency
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    License Number       |    
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    License Number State |    
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