Provider Demographics
NPI:1356780829
Name:PICKENS ADULT DAYCARE CENTER
Entity type:Organization
Organization Name:PICKENS ADULT DAYCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:601-278-6739
Mailing Address - Street 1:1032 PEYTON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-7013
Mailing Address - Country:US
Mailing Address - Phone:601-278-6739
Mailing Address - Fax:
Practice Address - Street 1:345 HWY 51 N
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:MS
Practice Address - Zip Code:39146
Practice Address - Country:US
Practice Address - Phone:601-278-6739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker