Healthcare Provider Details

I. General information

NPI: 1780831032
Provider Name (Legal Business Name): PEC REFERRAL SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 SOUTH RIDGE CENTER BOX 121
GREENVILLE MS
38702-0121
US

IV. Provider business mailing address

2353 SOUTH RIDGE CENTER BOX 121
GREENVILLE MS
38702-0121
US

V. Phone/Fax

Practice location:
  • Phone: 662-334-6335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number60609
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number60609
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number60609
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number60609
License Number StateMS

VIII. Authorized Official

Name: GWEN HERMAN
Title or Position: OWNER
Credential:
Phone: 662-334-6335