Provider Demographics
NPI:1154611085
Name:ELITE ADULT DAYCARE CENTER
Entity type:Organization
Organization Name:ELITE ADULT DAYCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-723-0034
Mailing Address - Street 1:P.O. BOX 162
Mailing Address - Street 2:101 BIZZELL STREET
Mailing Address - City:PACE
Mailing Address - State:MS
Mailing Address - Zip Code:38764-0162
Mailing Address - Country:US
Mailing Address - Phone:662-723-0034
Mailing Address - Fax:662-723-0034
Practice Address - Street 1:101 BIZZELL STREET
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:MS
Practice Address - Zip Code:38764-0162
Practice Address - Country:US
Practice Address - Phone:662-723-0034
Practice Address - Fax:662-723-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care