Organization
EMMANUEL RIDGE OF LOUISVILLE MS INC
Active
Other names
ADULT DAY HEALTH SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BEATRICE A EZEM RN,CM,CLNC (CEO)
(601) 927-9839
Entity
Organization
Contact information
Practice address
803 W MAIN ST, LOUISVILLE, MS 39339-2539
(662) 705-5031
(662) 705-5034
Mailing address
750 BOLING ST, SUITE H, JACKSON, MS 39209-2652
(769) 233-7437
(769) 251-0257
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
R815521
MS
251T00000X
PACE Provider Organization
Primary
08752218
MS
253Z00000X
In Home Supportive Care Agency
03630719
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08752218
—
MS
Enumeration date
01/16/2015
Last updated
01/16/2015
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