=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962638791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOICES FOR CHILDREN AND FAMILY - FOREST HILL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2009
-----------------------------------------------------
Last Update Date | 04/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2607 RAYMOND RD
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39212-2252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-775-9800
-----------------------------------------------------
Fax | 225-775-8149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6639 SULLIVAN RD
-----------------------------------------------------
City | GREENWELL SPRINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70739-3112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-261-0160
-----------------------------------------------------
Fax | 225-775-8149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. ANNETTE AUSTIN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 225-261-0160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------