1285179705 NPI number — C&K ADULT RECREATIONAL AND HOMECARE SERVICES

Table of content: (NPI 1285179705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285179705 NPI number — C&K ADULT RECREATIONAL AND HOMECARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C&K ADULT RECREATIONAL AND HOMECARE SERVICES
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:
1285179705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 314
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DREW
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38737-0314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-482-5067
Provider Business Mailing Address Fax Number:
662-482-5076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
288 GREEN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DREW
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38737-0314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-482-5067
Provider Business Practice Location Address Fax Number:
662-482-5076
Provider Enumeration Date:
12/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
TISHIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
662-482-5067

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com