Organization
NORTH DELTA ADULT DAYCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND EARL VALLIER (CEO/ADMINISTRATOR)
(662) 393-6128
Entity
Organization
Contact information
Practice address
1200 STATELINE RD W, SOUTHAVEN, MS 38671-1430
(662) 393-6128
(662) 342-0655
Mailing address
1200 STATELINE RD W, SOUTHAVEN, MS 38671-1430
(662) 393-6128
(662) 342-0655
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
04/15/2013
Last updated
04/15/2013
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