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General NPI Number Information
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NPI Number | 1902055767
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Entity Type | Organization
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Legal Business Name | WORD OF DELIVERANCE ADULT DAY CARE
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 509 DAVIS AVENUE
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City | CLEVELAND
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State | MS
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Zip | 38732
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Country | US
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Telephone | 662-402-1970
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Fax |
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Provider Business Mailing Address
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Address Line | 503 DAVIS AV
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City | CLEVELAND
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State | MS
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Zip | 38732
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Country | US
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Telephone | 662-402-1970
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ANNIE PEARL BROWN-WILLIAMS
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Credential |
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Telephone | 662-402-1970
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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 | 4000
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License Number State | MS
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