Organization
WILLIE MAE CLERK ADULT DAY CARE ,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JOSEPHINE CLERK RN (EXECUTIVE DIRECTOR)
(662) 846-7732
Entity
Organization
Contact information
Practice address
151 GAINES HWY, BOYLE, MS 38730-9512
(662) 846-7732
(662) 846-7732
Mailing address
PO BOX 155, BOYLE, MS 38730-0155
(662) 846-7732
(662) 846-7732
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
08133227
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08133227
—
MS
Enumeration date
05/01/2015
Last updated
05/01/2015
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