NPI 1386369726

Porosha Gaines, IDDWAIVERSERVICES

Practitioner Day Training/Habilitation Specialist Ellisville, MS

Practice location

Address: 106 Mize St APT 26, Ellisville, MS 39437-2067
Phone: (601) 800-8564
Mailing address: PO Box 18679, Hattiesburg, MS 39404-8679

Registered specialties

Day Training/Habilitation Specialist Primary

Nursing Service Related Providers Taxonomy 373H00000X

Other Day Training/Habilitation Specialist providers in Mississippi →

Registry record

NPI: 1386369726
Entity type: Individual
Sex (as registered): Female
NPI issued: 7 Oct 2022
Record last updated: 7 Oct 2022

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.