Provider Demographics
NPI:1275747289
Name:SENIOR CARE CENTERS OF MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:SENIOR CARE CENTERS OF MISSISSIPPI, LLC
Other - Org Name:BAPTIST ADULT DAY HEALTH SERVICES OF N. JACKSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEHNERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-642-6600
Mailing Address - Street 1:7 NESHAMINY INTERPLEX
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053
Mailing Address - Country:US
Mailing Address - Phone:215-642-6600
Mailing Address - Fax:215-642-6610
Practice Address - Street 1:6250 OLD CANTON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2946
Practice Address - Country:US
Practice Address - Phone:601-956-7794
Practice Address - Fax:601-206-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770373Medicaid