Organization
FONDREN NIGHTINGALES SENIOR DAY RETREAT CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGG LEVY LPN (CEO)
(601) 398-4485
Entity
Organization
Contact information
Practice address
3321 N WEST ST, JACKSON, MS 39216-3039
(601) 398-4485
(601) 398-1492
Mailing address
3321 N WEST ST, JACKSON, MS 39216-3039
(601) 398-4485
(601) 398-1492
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QA0600X
Adult Day Care Clinic/Center
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053622134
—
MS
Enumeration date
08/29/2018
Last updated
08/31/2021
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