Healthcare Provider Details

I. General information

NPI: 1194199042
Provider Name (Legal Business Name): THE ARC SOUTHEAST MISSISSIPPI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 BONHOMIE RD
HATTIESBURG MS
39401-8648
US

IV. Provider business mailing address

PO BOX 18800
HATTIESBURG MS
39404-8800
US

V. Phone/Fax

Practice location:
  • Phone: 601-583-4251
  • Fax: 601-583-4251
Mailing address:
  • Phone: 601-580-0636
  • Fax: 601-583-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER P MOSS
Title or Position: TREASURER
Credential:
Phone: 601-580-0636