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General NPI Number Information
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NPI Number | 1033143284
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Entity Type | Organization
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Legal Business Name | SOUTH MISSISSIPPI REGIONAL CENTER
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1170 W RAILROAD ST
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City | LONG BEACH
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State | MS
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Zip | 39560-4106
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Country | US
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Telephone | 228-867-1300
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Fax | 228-214-5563
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Provider Business Mailing Address
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Address Line | 1170 W RAILROAD ST
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City | LONG BEACH
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State | MS
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Zip | 39560-4106
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Country | US
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Telephone | 228-867-1300
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Fax | 228-214-5563
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Authorized Official
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Title or Position | DIRECTOR OF FACILITY
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Name | PAMELA BAKER
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Credential | PHD
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Telephone | 228-867-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 311
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License Number State | MS
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