Healthcare Provider Details

I. General information

NPI: 1831243070
Provider Name (Legal Business Name): WILLOWOOD DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 BOLING ST
JACKSON MS
39213-4418
US

IV. Provider business mailing address

1635 BOLING ST
JACKSON MS
39213-4418
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-0123
  • Fax:
Mailing address:
  • Phone: 601-366-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CURTIS E. ALFORD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-366-0123