Organization
WILLIE MAE CLERK ADULT DAY CARE ,LLC
Active
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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