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Organization Active NPI Community/Behavioral Health Agency · Wiggins, MS
NPI 1689933764 · NPPES record last updated May 10, 2012
Key facts
- NPI
- 1689933764
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- 1063 (MS)
- Legal business name
- CHRISTIAN FELLOWSHIP HOME
- Practice address
- 918 Parkway Dr
Wiggins, MS 39577-8750 - Phone
- (601) 928-1871
- NPI assigned
- May 10, 2012
- Organization subpart
- No
Authorized official
- Name
- Mrs. Terrell Berry Boone, LPN
- Title
- Owner
- Phone
- (601) 928-1871
National Provider Directory
Locations
918 Parkway Dr
Wiggins, MS 39577
Phone (601) 928-1871
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 1063 | MS | Yes |
Addresses
Primary practice location
918 Parkway Dr
Wiggins, MS 39577-8750
Mailing address
918 Parkway Dr
Wiggins, MS 39577-8750
Phone (601) 928-1871
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063 | Medicaid | MS |
Other providers in Wiggins, MS
- Mary Catherine Buzhardt
- Jackson Thomas Cain
- Joseph J. Cain
- Logan Campbell
- Children'S International, LLC
- Coastal Family Health Center, Inc
- Coastal Family Health Center, Inc.
- Christopher Collins
- Ray L Cooley
- Cornerstone Chiropractic PLLC
All providers in Wiggins, MS · Community/Behavioral Health Agency in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.