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General NPI Number Information
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NPI Number | 1689421869
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Entity Type | Organization
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Legal Business Name | STUDENT ADVOCACY &FAMILY ENGAGEMENT
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Dates
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Enumeration Date | 05/04/2024
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 554 BROADMOOR DR
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City | JACKSON
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State | MS
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Zip | 39206-4834
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Country | US
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Telephone | 601-454-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 554 BROADMOOR DR
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City | JACKSON
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State | MS
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Zip | 39206-4834
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Country | US
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Telephone | 601-454-9990
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Fax |
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Authorized Official
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Title or Position | CHEIF EXECUTIVE OFFICER
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Name | TIFFANI WATTS
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Credential |
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Telephone | 601-454-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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