Provider Demographics
NPI:1811134778
Name:MOUNT ZION ADULT DAY CARE
Entity type:Organization
Organization Name:MOUNT ZION ADULT DAY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:601-249-1999
Mailing Address - Street 1:4027 FRED MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-8019
Mailing Address - Country:US
Mailing Address - Phone:601-249-1999
Mailing Address - Fax:
Practice Address - Street 1:4027 FRED MARTIN RD
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666-8019
Practice Address - Country:US
Practice Address - Phone:601-249-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MT. ZION ECONOMIC COMMUNITY CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-14
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
MS302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care