Healthcare Provider Details

I. General information

NPI: 1649790031
Provider Name (Legal Business Name): MISSISSIPPI BAPTIST MINISTRY FOR CHILDREN AND FAMILIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DAVID PATTERSON RD
MOSELLE MS
39459-9439
US

IV. Provider business mailing address

PO BOX 334
MOSELLE MS
39459-0334
US

V. Phone/Fax

Practice location:
  • Phone: 601-596-3786
  • Fax:
Mailing address:
  • Phone: 601-596-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRENT F BROOME
Title or Position: EXECUTIVE DIRECTOR
Credential: CD
Phone: 601-596-3786