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General NPI Number Information
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NPI Number | 1679943310
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Entity Type | Organization
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Legal Business Name | EDUCARE SENIOR DAY CENTER (VICKSBURG BRANCH)
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 3202 WISCONSIN AVE
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City | VICKSBURG
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State | MS
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Zip | 39180-5351
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Country | US
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Telephone | 601-624-0311
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Fax | 866-683-2362
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Provider Business Mailing Address
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Address Line | 4005 TORREY PINES DR
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City | BYRAM
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State | MS
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Zip | 39272-5778
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Country | US
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Telephone | 601-624-0311
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANGELA COURTNEY
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Credential |
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Telephone | 601-624-0311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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