Provider Demographics
NPI:1609391200
Name:TUNICA ADULT DAY CARE SERVICES
Entity Type:Organization
Organization Name:TUNICA ADULT DAY CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:662-392-1064
Mailing Address - Street 1:1530 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-9372
Mailing Address - Country:US
Mailing Address - Phone:662-363-2001
Mailing Address - Fax:
Practice Address - Street 1:1530 EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676-9372
Practice Address - Country:US
Practice Address - Phone:662-363-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care