Provider Demographics
NPI:1639558588
Name:WEST CLEVELAND ADULT DAYCARE
Entity Type:Organization
Organization Name:WEST CLEVELAND ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVENSON
Authorized Official - Middle Name:UNDAE
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:662-347-1122
Mailing Address - Street 1:314 OLD RULEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732
Mailing Address - Country:US
Mailing Address - Phone:662-347-1122
Mailing Address - Fax:662-545-4695
Practice Address - Street 1:1210 W HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2263
Practice Address - Country:US
Practice Address - Phone:662-347-1122
Practice Address - Fax:662-545-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care