1073990917 NPI number — NORTH MISSISSIPPI ADULT DAY CARE SERVICES LLC

Table of content: LAURA SOUDANT CNS, LDN (NPI 1881421543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073990917 NPI number — NORTH MISSISSIPPI ADULT DAY CARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH MISSISSIPPI ADULT DAY CARE SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073990917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
714 E SERVICE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLDWATER
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38618-3881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-622-0180
Provider Business Mailing Address Fax Number:
662-622-0189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
714 E SERVICE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLDWATER
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38618-3881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-622-0180
Provider Business Practice Location Address Fax Number:
662-622-0189
Provider Enumeration Date:
04/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
OZELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
662-622-0180

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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