Healthcare Provider Details

I. General information

NPI: 1770901688
Provider Name (Legal Business Name): METHODIST CHILDREN'S HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 03/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N FLAG CHAPEL RD
JACKSON MS
39209-2208
US

IV. Provider business mailing address

805 N FLAG CHAPEL RD
JACKSON MS
39209-2208
US

V. Phone/Fax

Practice location:
  • Phone: 601-853-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. DEVON LOGGINS
Title or Position: VICE PRESIDENT OF PROGRAMS
Credential: LCSW
Phone: 601-853-5000