Organization
FULL POTENTIAL ADULT DAYCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMEKIA RENIX JACKSON (CEO)
(662) 563-0690
Entity
Organization
Contact information
Practice address
405 HIGHWAY 51 S, BATESVILLE, MS 38606-2549
(662) 563-0690
(662) 563-7304
Mailing address
405 HIGHWAY 51 S, BATESVILLE, MS 38606-2549
(662) 563-0690
(662) 563-7304
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07031582
—
MS
Enumeration date
10/30/2019
Last updated
10/30/2019
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