Organization
ST JOHN'S ADULT DAY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE BRADFORD JR. (MANAGING DIRECTOR)
(662) 647-1766
Entity
Organization
Contact information
Practice address
517 E BAKER ST, INDIANOLA, MS 38751-2503
(662) 647-1766
Mailing address
517 E BAKER ST, INDIANOLA, MS 38751-2503
(662) 647-1766
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
11/02/2016
Last updated
11/02/2016
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