NPI 1790954592

Heavenly Palace Adult Center, INC.

Organisation Preferred Provider Organization Greenville, MS

Practice location

Address: 1654 Highway 1 N, Greenville, MS 38701-0000
Phone: (662) 378-7262
Mailing address: 1654 Highway 1 N, Greenville, MS 38703-1943

Authorised official

Name: Patrick Jackson
Title: President
Phone: (662) 378-7262

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 07186736 (MS)

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Registry record

NPI: 1790954592
Entity type: Organization
NPI issued: 26 Feb 2008
Record last updated: 26 Feb 2008

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.