| NPI | 1497170260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KWANTRELL GREEN President 228-547-4424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health (Licence: MS 01541356) |
| Additional Taxonomies | 261QA0600X Clinic/Center Adult Day Care (Licence: MS 03873054) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2014-03-03 |