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Organization

PROVIDENCE PCC OF GRENADA, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. DEBBIE P MITCHELL (EXECUTIVE DIRECTOR)
(662) 226-8556
Entity
Organization

Contact information

Practice address
1855 HILL DR, GRENADA, MS 38901-5003
(662) 226-8556
(662) 229-0556
Mailing address
1855 HILL DR, GRENADA, MS 38901-5003
(662) 226-8556
(662) 229-0556

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
777
MS

Other

Enumeration date
08/23/2010
Last updated
08/23/2010
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