| NPI | 1780972026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELYNN SMITH Operations Manager 601-831-1090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2011-07-20 |