| Ideal Provider, Llc | |
|
8869 Centre St # 3 Southaven MS 38671-1725 | |
| (662) 342-7023 | |
| (662) 342-7089 |
| Full Name | Ideal Provider, Llc |
|---|---|
| Speciality | Respite Care |
| Location | 8869 Centre St # 3, Southaven, Mississippi |
| Authorized Official Name and Position | Ngozi Edmunds (PRESIDENT) |
| Authorized Official Contact | 6623427023 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ideal Provider, Llc 8869 Centre St Southaven MS 38671-1725 Ph: (662) 342-7023 | Ideal Provider, Llc 8869 Centre St # 3 Southaven MS 38671-1725 Ph: (662) 342-7023 |
| NPI Number | 1013141357 |
|---|---|
| Provider Enumeration Date | 05/13/2009 |
| Last Update Date | 05/13/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013141357 | NPI | - | NPPES |
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