Provider Demographics
NPI:1023492063
Name:OUR HOUSE OF MAYERSVILLE ADULT DAY SERVICES
Entity type:Organization
Organization Name:OUR HOUSE OF MAYERSVILLE ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:662-394-9853
Mailing Address - Street 1:564 CYPRESS LN APT 812
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7423
Mailing Address - Country:US
Mailing Address - Phone:662-394-9853
Mailing Address - Fax:662-873-2285
Practice Address - Street 1:564 CYPRESS LN APT 512
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7470
Practice Address - Country:US
Practice Address - Phone:662-873-6559
Practice Address - Fax:662-873-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care