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General NPI Number Information
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NPI Number | 1740524099
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Entity Type | Organization
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Legal Business Name | SOUTH WEST ADULT DAY CARE
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 5638 TERRY RD
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City | BYRAM
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State | MS
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Zip | 39272-9200
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Country | US
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Telephone | 601-919-6131
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 BROOKLEIGH DR
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City | BYRAM
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State | MS
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Zip | 39272-6009
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Country | US
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Telephone | 601-919-6131
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHEILA ELAINE WILLIAMS
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Credential |
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Telephone | 601-919-6131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | NO LIC FOR MS
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License Number State | MS
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