Organization
COMMUNITY ADULT DAY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BEVERLY C JOHNSON MSW (ADMINISTRATOR)
(662) 719-2005
Entity
Organization
Contact information
Practice address
114 S EDWARDS AVENUE, MOUND BAYOU, MS 38762
(662) 719-2005
Mailing address
404 HOLT ST, BOX 3, MOUND BAYOU, MS 38762-9759
(662) 719-2005
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
MS
Other
Enumeration date
03/20/2013
Last updated
03/20/2013
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