Healthcare Provider Details

I. General information

NPI: 1184767568
Provider Name (Legal Business Name): COMMUNITY DEVELOPMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N FRONT ST
RICHTON MS
39476-2201
US

IV. Provider business mailing address

200 N FRONT ST
RICHTON MS
39476-2201
US

V. Phone/Fax

Practice location:
  • Phone: 601-788-5865
  • Fax: 601-788-5722
Mailing address:
  • Phone: 601-788-5865
  • Fax: 601-788-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. OMA FAYE HIBBLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-788-5865