Provider Demographics
NPI:1962956037
Name:WONDER YEARS
Entity type:Organization
Organization Name:WONDER YEARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-561-2799
Mailing Address - Street 1:112 LAWSON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-1833
Mailing Address - Country:US
Mailing Address - Phone:662-563-2799
Mailing Address - Fax:
Practice Address - Street 1:303 PATTON LN
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-5431
Practice Address - Country:US
Practice Address - Phone:662-561-2799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care