# CENTER FOR FAMILY LIFE EXTENSION, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053682724
- **Authorized official:** ELMINA JOHNSON (OWNER)
- **Authorized official phone:** (601) 259-5745

## Contact information

- **Practice address:** 1980 HIGHWAY 80 W, JACKSON, MS 39204-2303
- **Practice address phone:** (601) 259-5745
- **Practice address fax:** (601) 871-8223
- **Mailing address:** 1980 HIGHWAY 80 W, JACKSON, MS 39204-2303
- **Mailing address phone:** (601) 259-5745

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | CYS-CFL-TGH-01 | MS | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | CYS-CFL-TGH-01 | MS | Yes |

## Other

- **Enumeration date:** 01/26/2012
- **Last updated:** 03/22/2021