NPI 1013141357

Ideal Provider, LLC

Organisation Respite Care Southaven, MS

Practice location

Address: 8869 Centre St # 3, Southaven, MS 38671-1725
Phone: (662) 342-7023
Fax: (662) 342-7089
Mailing address: 8869 Centre St, Southaven, MS 38671-1725

Authorised official

Name: Ngozi Edmunds
Title: President
Phone: (662) 342-7023

Registered specialties (3)

Respite Care Primary

Respite Care Facility Taxonomy 385H00000X

Other Respite Care providers in Mississippi →

Adolescent and Children Mental Health Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QM0855X

Other Clinic/Center providers in Mississippi →

Long Term Care Hospital

Hospitals Taxonomy 282E00000X

Other Long Term Care Hospital providers in Mississippi →

Registry record

NPI: 1013141357
Entity type: Organization
NPI issued: 13 May 2009
Record last updated: 13 May 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.