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General NPI Number Information
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NPI Number | 1558769927
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Entity Type | Organization
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Legal Business Name | JUST LIKE HOME ADULT DAY CARE LLC
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 216 FRONT STREET EXT
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City | INDIANOLA
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State | MS
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Zip | 38751-2861
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Country | US
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Telephone | 662-207-9432
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Fax | 662-608-6783
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Provider Business Mailing Address
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Address Line | 216 FRONT STREET EXT
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City | INDIANOLA
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State | MS
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Zip | 38751-2861
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Country | US
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Telephone | 662-207-9432
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Fax | 662-608-6783
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Authorized Official
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Title or Position | OWNER
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Name | MRS. WINNIE H COLEMAN
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Credential |
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Telephone | 662-207-9432
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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 | MS
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