Provider Demographics
NPI: | 1255694584 |
---|---|
Name: | IN HIS PRESENCE DAYCARE MS |
Entity Type: | Organization |
Organization Name: | IN HIS PRESENCE DAYCARE MS |
Other - Org Name: | IN HIS PRESENCE DAYCARE |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | CEO/OWNER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | CHANDRA |
Authorized Official - Middle Name: | RENA |
Authorized Official - Last Name: | JONES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 663-931-3646 |
Mailing Address - Street 1: | 504 BASKET STREET |
Mailing Address - Street 2: | |
Mailing Address - City: | ITTA BENA |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 38941 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 662-931-3646 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 504 BASKET ST |
Practice Address - Street 2: | |
Practice Address - City: | ITTA BENA |
Practice Address - State: | MS |
Practice Address - Zip Code: | 38941-3206 |
Practice Address - Country: | US |
Practice Address - Phone: | 662-931-3646 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-06-21 |
Last Update Date: | 2012-06-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MS | 802051112 | 261QA0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |