Organization
WOODLAND ADULT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JERRY SULLIVAN (OWNER)
(662) 456-0133
Entity
Organization
Contact information
Practice address
101 MARKET ST, WOODLAND, MS 39776-9105
(662) 456-0111
(662) 456-0111
Mailing address
PO BOX 186, WOODLAND, MS 39776-0186
(662) 456-0133
(662) 456-7335
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0114346
—
MS
Enumeration date
08/30/2017
Last updated
06/16/2018
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