Organization
ELISE'S PLACE ADC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQUELINE HANNAH (DIRECTOR)
(662) 207-9842
Entity
Organization
Contact information
Practice address
924 BROADMOOR DR, INDIANOLA, MS 38751-3608
(662) 207-9842
Mailing address
924 BROADMOOR DR, INDIANOLA, MS 38751-3608
16622079842
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
MS
Other
Enumeration date
05/17/2017
Last updated
05/17/2017
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