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General NPI Number Information
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NPI Number | 1659790152
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Entity Type | Organization
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Legal Business Name | LIGHT OF THE WORLD ADULT DAY CARE, LLC
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Dates
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Enumeration Date | 04/11/2014
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Last Update Date | 04/11/2014
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Provider Practice Location Address
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Address Line | 405 W GRESHAM ST
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City | INDIANOLA
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State | MS
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Zip | 38751-2053
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Country | US
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Telephone | 662-207-3744
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Fax |
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Provider Business Mailing Address
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Address Line | 405 W GRESHAM ST
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City | INDIANOLA
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State | MS
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Zip | 38751-2053
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Country | US
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Telephone | 662-207-3744
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TERRY HUTCHINS
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Credential |
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Telephone | 662-207-3744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 111111111
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License Number State | MS
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