Provider Demographics
NPI:1316452501
Name:PROFESSIONAL STAFFING SOLUTIONS ADULT DAY SERVICES, LLC
Entity type:Organization
Organization Name:PROFESSIONAL STAFFING SOLUTIONS ADULT DAY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PANDORA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-822-1924
Mailing Address - Street 1:PO BOX 4580
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-4580
Mailing Address - Country:US
Mailing Address - Phone:662-335-5554
Mailing Address - Fax:662-335-5580
Practice Address - Street 1:1633 BROADWAY EXT N # P
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-1942
Practice Address - Country:US
Practice Address - Phone:662-335-5554
Practice Address - Fax:662-335-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863014372600000X, 376J00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06908787Medicaid
MS07331397Medicaid
MS08679792Medicaid