Organization
SOUTH WEST ADULT DAY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA ELAINE WILLIAMS (ADMINISTRATOR)
(601) 919-6131
Entity
Organization
Contact information
Practice address
5638 TERRY RD, BYRAM, MS 39272-9200
(601) 919-6131
Mailing address
5210 BROOKLEIGH DR, BYRAM, MS 39272-6009
(601) 919-6131
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
NO LIC FOR MS
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215284278
MEDICARE CERTIFICATION IS PENDING
MS
Enumeration date
11/26/2012
Last updated
11/26/2012
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