Provider Demographics
NPI:1619484482
Name:SILVER LIGHT ADULT DAYCARE, LLC
Entity Type:Organization
Organization Name:SILVER LIGHT ADULT DAYCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:769-218-7005
Mailing Address - Street 1:142 CALLAWAY CIR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-4499
Mailing Address - Country:US
Mailing Address - Phone:769-218-7005
Mailing Address - Fax:601-665-4430
Practice Address - Street 1:142 CALLAWAY CIR
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-4499
Practice Address - Country:US
Practice Address - Phone:769-218-7005
Practice Address - Fax:601-665-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care