Organization
LIFE CHANGING ADULT DAYCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAMELA LORRAINE RANDLE (OWNER)
(662) 207-3645
Entity
Organization
Contact information
Practice address
305 BIRCH AVE, INDIANOLA, MS 38751-2107
(662) 207-3645
Mailing address
PO BOX 53, 2110 KINLOCK ROAD, INDIANOLA, MS 38751-0053
(662) 207-3645
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/12/2016
Last updated
01/12/2016
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