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General NPI Number Information
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NPI Number | 1134615248
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI SUPERIOR SENIOR SERVICES
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 6340 KILN DELISLE RD STE A
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-9719
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Country | US
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Telephone | 228-255-9225
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Fax | 228-255-7019
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Provider Business Mailing Address
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Address Line | 6340 KILN DELISLE RD STE A
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-9719
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Country | US
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Telephone | 228-255-9225
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Fax | 228-255-7019
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LIBERTY FONTANA
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Credential |
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Telephone | 228-255-9225
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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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