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General NPI Number Information
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NPI Number | 1700562287
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Entity Type | Organization
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Legal Business Name | MICAH'S WALK FOR AUTISM
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 424 SHADOWOOD DR
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City | RIDGELAND
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State | MS
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Zip | 39157-4155
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Country | US
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Telephone | 662-263-6044
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Fax |
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Provider Business Mailing Address
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Address Line | 424 SHADOWOOD DR
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City | RIDGELAND
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State | MS
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Zip | 39157-4155
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Country | US
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Telephone | 662-263-6044
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PRESIDENT/CEO
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Name | CHRISTE TASHAY FORD MCBRIDE
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Credential | LPN, B.S.H.A.
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Telephone | 662-263-6044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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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 | 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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