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General NPI Number Information
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NPI Number | 1467705277
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Entity Type | Organization
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Legal Business Name | BAPTIST HOMES INC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 461 GOODLOE RD
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City | CANTON
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State | MS
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Zip | 39046-9740
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Country | US
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Telephone | 601-859-2100
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Fax | 601-859-2105
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Provider Business Mailing Address
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Address Line | PO BOX 406
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City | CANTON
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State | MS
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Zip | 39046-0406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | WILLIAM MCCORMACK
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Credential |
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Telephone | 601-859-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number | SV-BIDD-SVLS-01
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License Number State | MS
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