Provider Demographics
NPI:1649643578
Name:REACHING OUR COMMUNITY YOUTH AND ADULT DAYCARE
Entity type:Organization
Organization Name:REACHING OUR COMMUNITY YOUTH AND ADULT DAYCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRON
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-624-4239
Mailing Address - Street 1:469 E. NORTHSIDE DR
Mailing Address - Street 2:109 ANGELIA LANE
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3467
Mailing Address - Country:US
Mailing Address - Phone:601-488-4765
Mailing Address - Fax:601-488-4778
Practice Address - Street 1:469 E NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-3467
Practice Address - Country:US
Practice Address - Phone:601-488-4765
Practice Address - Fax:601-488-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-RiskGroup - Single Specialty
No347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05386051Medicaid