Provider Demographics
NPI:1679943310
Name:EDUCARE SENIOR DAY CENTER (VICKSBURG BRANCH)
Entity type:Organization
Organization Name:EDUCARE SENIOR DAY CENTER (VICKSBURG BRANCH)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-624-0311
Mailing Address - Street 1:4005 TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-5778
Mailing Address - Country:US
Mailing Address - Phone:601-624-0311
Mailing Address - Fax:
Practice Address - Street 1:3202 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5351
Practice Address - Country:US
Practice Address - Phone:601-624-0311
Practice Address - Fax:866-683-2362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDUCARE SENIOR DAY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home