Ideal Provider, LLC
NPI #1013141357 in Southaven, Mississippi
Provider Information
- NPI Number
- 1013141357
- Entity Type
- Organization
- Organization Name
- Ideal Provider, LLC
- Primary Specialty
- Respite Care
- Enumeration Date
- May 13, 2009
- Last Updated
- May 13, 2009
Practice Location
- Address
- 8869 CENTRE ST # 3
- City
- Southaven
- State
- Mississippi
- ZIP Code
- 38671-1725
- Phone
- (662) 342-7023
Authorized Official
- Name
- NGOZI EDMUNDS
- Title
- PRESIDENT
- Phone
- (662) 342-7023
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health |
| Long Term Care Hospital |
| Respite Care |
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