Individual
JACQUELINE HANNAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
924 BROADMOOR DR, INDIANOLA, MS 38751-3608
(662) 207-9842
Mailing address
924 BROADMOOR DR, INDIANOLA, MS 38751-3608
(662) 207-9842
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
—
MS
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
—
—
Other
Enumeration date
05/26/2015
Last updated
03/09/2017
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