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General NPI Number Information
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NPI Number | 1629550363
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Entity Type | Organization
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Legal Business Name | FONDREN NIGHTINGALES SENIOR DAY RETREAT CO
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 3321 N WEST ST
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City | JACKSON
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State | MS
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Zip | 39216-3039
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Country | US
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Telephone | 601-398-4485
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Fax | 601-398-1492
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Provider Business Mailing Address
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Address Line | 3321 N WEST ST
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City | JACKSON
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State | MS
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Zip | 39216-3039
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Country | US
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Telephone | 601-398-4485
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Fax | 601-398-1492
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Authorized Official
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Title or Position | CEO
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Name | GREGG LEVY
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Credential | LPN
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Telephone | 601-398-4485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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