Provider Demographics
NPI:1558893958
Name:SOUTHERN HOSPITALITY ADULT DAYCARE, LLC
Entity Type:Organization
Organization Name:SOUTHERN HOSPITALITY ADULT DAYCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONTRILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-299-7280
Mailing Address - Street 1:1501 VANCE RD
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4830
Mailing Address - Country:US
Mailing Address - Phone:662-307-2061
Mailing Address - Fax:662-307-2316
Practice Address - Street 1:1501 VANCE RD
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4830
Practice Address - Country:US
Practice Address - Phone:662-307-2061
Practice Address - Fax:662-307-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care