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General NPI Number Information
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NPI Number | 1578828331
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Entity Type | Organization
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Legal Business Name | SENIORS ON THE GO
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 14306 LEMOYNE BLVD
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City | BILOXI
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State | MS
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Zip | 39532-9760
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Country | US
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Telephone | 228-396-1998
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Fax | 228-396-2907
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Provider Business Mailing Address
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Address Line | 4490 KENDALL CIR
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City | GULFPORT
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State | MS
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Zip | 39507-4000
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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 | MELINDA SMITH
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Credential |
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Telephone | 228-254-0370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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