Healthcare Provider Details

I. General information

NPI: 1487982757
Provider Name (Legal Business Name): LIFE HELP INDUSTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 BROWNING ROAD 520
GREENWOOD MS
38930-6022
US

IV. Provider business mailing address

PO BOX 1505
GREENWOOD MS
38935-1505
US

V. Phone/Fax

Practice location:
  • Phone: 662-453-6211
  • Fax: 662-455-8724
Mailing address:
  • Phone: 662-453-6211
  • Fax: 662-455-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateMS

VIII. Authorized Official

Name: MADOLYN SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 662-453-6211