Provider Demographics
NPI:1558613505
Name:DODDSVILLE ADULT DAY CARE
Entity Type:Organization
Organization Name:DODDSVILLE ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-588-2000
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:RULEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38771-0698
Mailing Address - Country:US
Mailing Address - Phone:662-588-2000
Mailing Address - Fax:662-745-0141
Practice Address - Street 1:133 MILLER
Practice Address - Street 2:
Practice Address - City:DODDSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38736-8736
Practice Address - Country:US
Practice Address - Phone:662-588-2000
Practice Address - Fax:662-756-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSNONE REQUIRED305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization