Provider Demographics
NPI:1982955811
Name:PILGRIMS REST ADULT DAYCARE
Entity Type:Organization
Organization Name:PILGRIMS REST ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-741-2020
Mailing Address - Street 1:102 MCWILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:WINSTONVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38781
Mailing Address - Country:US
Mailing Address - Phone:662-741-2020
Mailing Address - Fax:
Practice Address - Street 1:102 MCWILLIAM ST
Practice Address - Street 2:
Practice Address - City:WINSTONVILLE
Practice Address - State:MS
Practice Address - Zip Code:38781
Practice Address - Country:US
Practice Address - Phone:662-741-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health