Provider Demographics
NPI:1134672686
Name:SOUTHERN SOLACE ADULT DAYCARE
Entity Type:Organization
Organization Name:SOUTHERN SOLACE ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-315-9384
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-0332
Mailing Address - Country:US
Mailing Address - Phone:901-607-7577
Mailing Address - Fax:662-233-5877
Practice Address - Street 1:116 S CENTER ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2627
Practice Address - Country:US
Practice Address - Phone:901-607-7577
Practice Address - Fax:662-233-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health