Provider Demographics
NPI:1841572393
Name:GA STOVER HEALTH CENTER PA
Entity Type:Organization
Organization Name:GA STOVER HEALTH CENTER PA
Other - Org Name:RUTH BURNETT ADULT DAY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-357-7602
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-0458
Mailing Address - Country:US
Mailing Address - Phone:662-357-7602
Mailing Address - Fax:662-357-7621
Practice Address - Street 1:226 E MAIN ST STE K
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2133
Practice Address - Country:US
Practice Address - Phone:662-357-7602
Practice Address - Fax:662-357-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility