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General NPI Number Information
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NPI Number | 1982080388
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Entity Type | Organization
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Legal Business Name | GOLDEN ANGELS ADULT DAYCARE, LLC
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 199 MARY MAGDALENE RD
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City | HATTIESBURG
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State | MS
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Zip | 39401-8435
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Country | US
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Telephone | 601-394-3941
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Fax | 601-928-5399
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Provider Business Mailing Address
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Address Line | 199 MARY MAGDALENE RD
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City | HATTIESBURG
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State | MS
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Zip | 39401-8435
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Country | US
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Telephone | 601-394-3941
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Fax | 601-928-5399
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | MRS. FREDA C COVINGTON
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Credential | REGISTERED NURSE
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Telephone | 601-394-3941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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