Provider Demographics
NPI:1275961393
Name:OURTIME ADULT DAY CARE SERVICES
Entity Type:Organization
Organization Name:OURTIME ADULT DAY CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:601-668-3752
Mailing Address - Street 1:350 W WOODROW WILSON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7683
Mailing Address - Country:US
Mailing Address - Phone:601-487-8402
Mailing Address - Fax:601-487-8460
Practice Address - Street 1:350 W WOODROW WILSON AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7683
Practice Address - Country:US
Practice Address - Phone:601-487-8402
Practice Address - Fax:601-487-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251S00000X251S00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251S00000XAgenciesCommunity/Behavioral Health