Provider Demographics
NPI:1013353309
Name:ADJR, LLC
Entity Type:Organization
Organization Name:ADJR, LLC
Other - Org Name:RUNNELS CREEK ADULT DAY CARE SVCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUDSPETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-587-1498
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-1337
Mailing Address - Country:US
Mailing Address - Phone:601-587-1498
Mailing Address - Fax:601-587-9226
Practice Address - Street 1:1134 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-7681
Practice Address - Country:US
Practice Address - Phone:601-587-9226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251QA0600X251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07684032Medicaid