Provider Demographics
NPI:1285179705
Name:C&K ADULT RECREATIONAL AND HOMECARE SERVICES
Entity Type:Organization
Organization Name:C&K ADULT RECREATIONAL AND HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TISHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-482-5067
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:DREW
Mailing Address - State:MS
Mailing Address - Zip Code:38737-0314
Mailing Address - Country:US
Mailing Address - Phone:662-482-5067
Mailing Address - Fax:662-482-5076
Practice Address - Street 1:288 GREEN AVENUE
Practice Address - Street 2:
Practice Address - City:DREW
Practice Address - State:MS
Practice Address - Zip Code:38737-0314
Practice Address - Country:US
Practice Address - Phone:662-482-5067
Practice Address - Fax:662-482-5076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care