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General NPI Number Information
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NPI Number | 1043952526
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Entity Type | Organization
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Legal Business Name | CLARKSDALE MS OPCO LLC
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 701 HIGHWAY 322
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City | CLARKSDALE
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State | MS
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Zip | 38614-4722
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Country | US
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Telephone | 662-627-2212
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Fax |
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Provider Business Mailing Address
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Address Line | 980 SYLVAN AVE
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-3301
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Country | US
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Telephone | 201-928-7800
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Fax |
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Authorized Official
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Title or Position | COO
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Name | BATYA GORELICK
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Credential |
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Telephone | 201-928-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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