Provider Demographics
NPI:1740724046
Name:NORTH STREET ADULT DAYCARE
Entity type:Organization
Organization Name:NORTH STREET ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-5758
Mailing Address - Street 1:222 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2746
Mailing Address - Country:US
Mailing Address - Phone:662-843-5758
Mailing Address - Fax:662-843-5311
Practice Address - Street 1:222 NORTH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2746
Practice Address - Country:US
Practice Address - Phone:662-843-5758
Practice Address - Fax:662-843-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty