| Organization Name: | CARNAGE TENDER LOVING CARE ADC |
| NPI Number: | 1104177567 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AUGUSTA CARNAGE (OWNER) |
| Mailing Address: | 102 Wheeler St Itta Bena |
| State: | MS US |
| Postal Code: | 389411919 |
| Phone Number: | 6622540011 |
| Fax Number: | 6622549511 |
| NPI Enumeration Date: | 09/26/2012 |
| NPI Last Update Date: | 09/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA0600X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Day Care |
| Taxonomy Definition: | |