Organization
STARKVILLE PEDIATRIC EXTENDED CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK HAMMOND (OWNER)
(251) 232-1518
Entity
Organization
Contact information
Practice address
9771 MS HIGHWAY 25, STARKVILLE, MS 39759-4944
(251) 232-1518
Mailing address
8178 SOLDIER CT, DAPHNE, AL 36526-6135
(251) 232-1518
Taxonomy
Speciality
Code
Description
License number
State
261QM3000X
Medically Fragile Infants and Children Day Care
Primary
—
—
Other
Enumeration date
07/26/2020
Last updated
07/26/2020
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