MEDICARE: STUDENT ADVOCACY &FAMILY ENGAGEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	172V00000X	Community Health Worker
2	177F00000X	Lodging Provider
3	251300000X	Local Education Agency (LEA)
4	251S00000X	Community/Behavioral Health Agency
5	252Y00000X	Early Intervention Provider Agency
6	276400000X	Substance Use Disorder Rehabilitation Hospital Unit
7	310400000X	Assisted Living Facility
8	3104A0625X	Assisted Living Facility (Mental Illness)
9	311500000X	Alzheimer Center (Dementia Center)
10	3245S0500X	Children's Substance Abuse Rehabilitation Facility
11	335G00000X	Medical Foods Supplier
12	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1689421869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUDENT ADVOCACY &FAMILY ENGAGEMENT

Provider Business Mailing Address
First Line	:	554 BROADMOOR DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-4834
Country	:	US
Telephone Number	:	601-454-9990
Fax Number	:

Provider Business Practice Location Address
First Line	:	554 BROADMOOR DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-4834
Country	:	US
Telephone Number	:	601-454-9990
Fax Number	:

Authorized Official
Title or Position	:	CHEIF EXECUTIVE OFFICER
Name	:	TIFFANI WATTS
Credential	:
Telephone Number	:	601-454-9990

Provider Enumeration Date	:	05/04/2024
Last Update Date	:	05/06/2024

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Directions to “STUDENT ADVOCACY &FAMILY ENGAGEMENT ” Practice Location

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