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General NPI Number Information
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NPI Number | 1740724046
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Entity Type | Organization
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Legal Business Name | NORTH STREET ADULT DAYCARE
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 222 NORTH ST
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City | CLEVELAND
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State | MS
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Zip | 38732-2746
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Country | US
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Telephone | 662-843-5758
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Fax | 662-843-5311
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Provider Business Mailing Address
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Address Line | 222 NORTH ST
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City | CLEVELAND
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State | MS
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Zip | 38732-2746
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Country | US
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Telephone | 662-843-5758
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Fax | 662-843-5311
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER GROSSLEY
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Credential |
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Telephone | 662-843-5758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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