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General NPI Number Information
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NPI Number | 1316452501
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL STAFFING SOLUTIONS ADULT DAY SERVICES, LLC
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Dates
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Enumeration Date | 12/09/2017
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 1633 BROADWAY EXT N # P
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City | GREENVILLE
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State | MS
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Zip | 38703-1942
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Country | US
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Telephone | 662-335-5554
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Fax | 662-335-5580
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Provider Business Mailing Address
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Address Line | PO BOX 4580
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City | GREENVILLE
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State | MS
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Zip | 38704-4580
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Country | US
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Telephone | 662-335-5554
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Fax | 662-335-5580
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. PANDORA REDMOND
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Credential | RN
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Telephone | 662-822-1924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | R863014
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | R863014
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | R863014
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License Number State | MS
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