Healthcare Provider Details

I. General information

NPI: 1821700972
Provider Name (Legal Business Name): STREAMS ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 WILL O WOOD BLVD
JACKSON MS
39212-3425
US

IV. Provider business mailing address

4230 WILL O WOOD BLVD
JACKSON MS
39212-3425
US

V. Phone/Fax

Practice location:
  • Phone: 601-351-5408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: THERESE BRIDGES
Title or Position: CEO
Credential:
Phone: 601-351-5408