Provider Demographics
NPI:1538716881
Name:PARKWAY SENIOR CARE GROUP INC
Entity type:Organization
Organization Name:PARKWAY SENIOR CARE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:AGYEI-KYEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-582-5801
Mailing Address - Street 1:P.O. BOX 15613
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404
Mailing Address - Country:US
Mailing Address - Phone:601-582-5805
Mailing Address - Fax:601-582-5806
Practice Address - Street 1:2503 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-582-5805
Practice Address - Fax:601-582-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No347C00000XTransportation ServicesPrivate Vehicle