Organization
EMMANUEL RIDGE OF DEKALB INC
Active
Other names
ADULT DAYCARE HEALTH SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BEATRICE EZEM RN,CM,CLNC (CEO)
(601) 927-9839
Entity
Organization
Contact information
Practice address
14632 HWY 39N/16E, DEKALB, MS 39328
(601) 927-9839
Mailing address
PO BOX 1522, FLORENCE, MS 39073-1522
(601) 927-9839
(769) 251-0257
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
R815521
MS
251T00000X
PACE Provider Organization
08752218
MS
253Z00000X
In Home Supportive Care Agency
03630719
MS
261QA0600X
Adult Day Care Clinic/Center
Primary
08752218
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08752218
—
MS
Enumeration date
04/15/2015
Last updated
04/15/2015
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