Organization
GULF GARDENS RESIDENTIAL AND COMMUNITY LIVING LLC
Active
Other names
GGRCL
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE C EDWARDS MSN, FNPC (DIRECTOR OF NURSING)
(678) 237-7183
Entity
Organization
Contact information
Practice address
460 BRIARWOOD DR STE 400, JACKSON, MS 39206-3062
(601) 203-1016
(601) 709-4611
Mailing address
460 BRIARWOOD DR STE 400, JACKSON, MS 39206-3062
(601) 203-1016
(601) 709-4611
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
05/25/2018
Last updated
09/01/2020
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