Provider Demographics
NPI:1912041849
Name:SOUTHERN COMMUNITY ADULT DAYCARE
Entity Type:Organization
Organization Name:SOUTHERN COMMUNITY ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:228-875-5123
Mailing Address - Street 1:1011 IBERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2919
Mailing Address - Country:US
Mailing Address - Phone:228-875-5123
Mailing Address - Fax:888-304-0019
Practice Address - Street 1:1011 IBERVILLE DR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2919
Practice Address - Country:US
Practice Address - Phone:228-875-5123
Practice Address - Fax:888-304-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09383320Medicaid