Provider Demographics
NPI:1891030516
Name:MOORHEAD ADULT DAYCARE
Entity Type:Organization
Organization Name:MOORHEAD ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-588-9510
Mailing Address - Street 1:119 E PERCY ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-6237
Mailing Address - Country:US
Mailing Address - Phone:662-588-9510
Mailing Address - Fax:
Practice Address - Street 1:107 SMITH ALLEY
Practice Address - Street 2:
Practice Address - City:SIDON
Practice Address - State:MS
Practice Address - Zip Code:38954-6237
Practice Address - Country:US
Practice Address - Phone:662-588-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services