Healthcare Provider Details

I. General information

NPI: 1306114376
Provider Name (Legal Business Name): NEW HORIZON MINISTRIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 WHEATLEY ST
JACKSON MS
39212-4714
US

IV. Provider business mailing address

1770 ELLIS AVE SUITE 200
JACKSON MS
39204-3613
US

V. Phone/Fax

Practice location:
  • Phone: 601-371-5070
  • Fax: 601-371-8282
Mailing address:
  • Phone: 601-371-1427
  • Fax: 601-371-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RONNIE CRUDUP JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-371-5070