Ideal Provider, LLC
Ideal Provider, LLC is an Adolescent and Children Mental Health Clinic/Center in Southaven, Mississippi. Registered with an NPI since 2009.
- In the registry since
- 2009
- Specialties on file
- 3
What do these letters mean?
- LLC — Limited liability company
- A form of business registration, not a clinical qualification.
Practice location Address checks out
8869 Centre St # 3Southaven, MS 38671-1725
Phone: (662) 342-7023
Fax: (662) 342-7089
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Respite Care (primary) | Taxonomy 385H00000X |
|---|---|
| Adolescent and Children Mental Health Clinic/Center | Taxonomy 261QM0855X |
| Long Term Care Hospital | Taxonomy 282E00000X |
Record details
| NPI number | 1013141357 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Ngozi Edmunds — President · (662) 342-7023 |
| NPI enumerated | May 13, 2009 |
| Last updated in NPPES | May 13, 2009 |
| Mailing address | 8869 Centre St, Southaven, MS 38671-1725 |