Healthcare Provider Details

I. General information

NPI: 1407063944
Provider Name (Legal Business Name): JOLIMAR SUMMIT RECOVERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 JOLIMAR TRL SE
SUMMIT MS
39666-7969
US

IV. Provider business mailing address

740 JOLIMAR TRL SE
SUMMIT MS
39666-7969
US

V. Phone/Fax

Practice location:
  • Phone: 601-276-9556
  • Fax: 601-276-9578
Mailing address:
  • Phone: 601-276-9556
  • Fax: 601-276-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateMS

VIII. Authorized Official

Name: JOHN M BASS
Title or Position: CEO
Credential: M.A., CCAP
Phone: 601-276-9556