Organization
CENTER FOR FAMILY LIFE EXTENSION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELMINA JOHNSON (OWNER)
(601) 259-5745
Entity
Organization
Contact information
Practice address
1980 HIGHWAY 80 W, JACKSON, MS 39204-2303
(601) 259-5745
(601) 871-8223
Mailing address
1980 HIGHWAY 80 W, JACKSON, MS 39204-2303
(601) 259-5745
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
CYS-CFL-TGH-01
MS
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
CYS-CFL-TGH-01
MS
Other
Enumeration date
01/26/2012
Last updated
03/22/2021
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