| NPI | 1053682724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELMINA JOHNSON Owner 601-259-5745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: MS CYS-CFL-TGH-01) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MS CYS-CFL-TGH-01) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2021-03-22 |