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General NPI Number Information
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NPI Number | 1497182448
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Entity Type | Organization
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Legal Business Name | BURRAGE'S INC
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Dates
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Enumeration Date | 10/07/2013
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Last Update Date | 10/07/2013
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Provider Practice Location Address
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Address Line | 363 HIGHLAND COLONY PKWY
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City | RIDGELAND
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State | MS
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Zip | 39157-6035
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Country | US
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Telephone | 601-991-0057
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16360
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City | JACKSON
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State | MS
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Zip | 39236-6360
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARY LYON
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Credential |
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Telephone | 601-720-6437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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