Provider Demographics
NPI:1710352505
Name:FAMILY FIRST PCS, LLC ADULT DAYCARE
Entity Type:Organization
Organization Name:FAMILY FIRST PCS, LLC ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HONDA
Authorized Official - Middle Name:CAPRI
Authorized Official - Last Name:DORTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-571-4099
Mailing Address - Street 1:120 JACKSON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-9600
Mailing Address - Country:US
Mailing Address - Phone:662-571-4099
Mailing Address - Fax:
Practice Address - Street 1:402 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3508
Practice Address - Country:US
Practice Address - Phone:662-571-4099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-06
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care