Center for Family Life Extension, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

CYS-CFL-TGH-01 Issued in MS

Legal business name

CENTER FOR FAMILY LIFE EXTENSION, INC.

Practice address

1980 Highway 80 W
Jackson, MS 39204-2303

Phone

(601) 259-5745

Fax

(601) 871-8223

NPI assigned

Jan 26, 2012

Last updated

Mar 22, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elmina Johnson

Title

Owner

Phone

(601) 259-5745

Specialties & licenses 2

Addresses

Tax ID family

Center for Family Life Extension Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Center for Family Life Extensions, Inc.

  • Community/Behavioral Health Agency
  • Jackson, MS
  • NPI 1033454772
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616371200000",
    "number": "1053682724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1980 HIGHWAY 80 W",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392042303",
            "telephone_number": "601-259-5745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1980 HIGHWAY 80 W",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392042303",
            "telephone_number": "601-259-5745",
            "fax_number": "601-871-8223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR FAMILY LIFE EXTENSION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-26",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ELMINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-259-5745"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MS",
            "license": "CYS-CFL-TGH-01",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MS",
            "license": "CYS-CFL-TGH-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latibbie Cavett, LPC
• Kaitlyn Cedoz, DO
• Bonnie Melissa Cefalu, DVM
• Celestial Health Creations
• Center for Diabetes Foot Care
• Center for Family Life Extensions, Inc.
• Center of Infectious Disease Excellence
• Centerwell Senior Primary Care Ms PC (CenterWell Senior Primary Care-Jackson East)
• Centerwell Senior Primary Care Ms PC (CenterWell Senior Primary Care-Jackson West)
• Central Jackson Family Medical Clinic

• Emotionally Disturbed Childrens' Residential Treatment Facility in Jackson, MS
• Providers in Jackson, MS by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.