OrganizationActive
Genesis and Light Center
NPI 1457768814 · Adult Day Care Clinic/Center · Jackson, MS
Provider details
- NPI number
- 1457768814
- Entity type
- Organization
- Primary specialty
- Adult Day Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Albert Wilson, Executive Director(601) 362-6736
- License
- 25C4PAS-5598 (MS)
Specialties & taxonomies
Ambulatory Health Care Facilities
Agencies
Practice location
4914 N State St
Jackson, MS 39206-4046
Phone: (601) 362-6736
Fax: (601) 362-6737
Approximate (ZIP-level) locationGet directions
Mailing address
4914 N State St
Jackson, MS 39206-4046
Registry dates
- Enumerated
- 2014-07-17
- Last updated
- 2023-03-17
- Certified
- 2023-03-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.