Healthcare Provider Details

I. General information

NPI: 1982980850
Provider Name (Legal Business Name): REGION IV CHEMICAL DEPENDENCY COMPLEX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NEW HOPE DR
CORINTH MS
38834-7458
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-7199
  • Fax: 662-286-8908
Mailing address:
  • Phone: 662-286-9883
  • Fax: 662-286-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLIE D SPEARMAN SR.
Title or Position: EXECUITIVE DIRECTOR
Credential:
Phone: 662-286-9883