=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225374903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARENTAL ADULT DAYCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2012
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 W MAIN ST
-----------------------------------------------------
City | MARKS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38646-1136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-326-4477
-----------------------------------------------------
Fax | 662-326-4478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 352
-----------------------------------------------------
City | WEBB
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38966-0352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-326-4477
-----------------------------------------------------
Fax | 662-326-4478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O
-----------------------------------------------------
Name | MRS. TRESSA I NASH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-375-2875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251T00000X
-----------------------------------------------------
Taxonomy Name | PACE Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------