Healthcare Provider Details

I. General information

NPI: 1447462395
Provider Name (Legal Business Name): MISSISSIPPI CHILDREN'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N WEST ST
JACKSON MS
39202-1032
US

IV. Provider business mailing address

1801 N WEST ST
JACKSON MS
39202-1032
US

V. Phone/Fax

Practice location:
  • Phone: 601-352-7784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateMS

VIII. Authorized Official

Name: CHRISTOPHER CHERNEY
Title or Position: CEO
Credential:
Phone: 601-352-7784