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General NPI Number Information
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NPI Number | 1619310182
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Entity Type | Organization
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Legal Business Name | NORTH DELTA ADULT DAYCARE
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 1200 STATELINE RD W
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1430
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Country | US
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Telephone | 662-393-6128
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Fax | 662-342-0655
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Provider Business Mailing Address
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Address Line | 1200 STATELINE RD W
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1430
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Country | US
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Telephone | 662-393-6128
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Fax | 662-342-0655
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | RAYMOND EARL VALLIER
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Credential |
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Telephone | 662-393-6128
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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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