Provider Demographics
NPI:1699201178
Name:SELECT CHOICE ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:SELECT CHOICE ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-641-6835
Mailing Address - Street 1:1201 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2815
Mailing Address - Country:US
Mailing Address - Phone:662-641-6835
Mailing Address - Fax:662-843-2096
Practice Address - Street 1:223 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:TUTWILER
Practice Address - State:MS
Practice Address - Zip Code:38963-5229
Practice Address - Country:US
Practice Address - Phone:662-641-6835
Practice Address - Fax:662-843-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care