Organization
SPECIALIZED TREATMENT FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANNON Y BUSH MPA (PROGRAM DIRECTOR)
(228) 328-6000
Entity
Organization
Contact information
Practice address
14426 JAMES BOND RD, GULFPORT, MS 39503-8311
(228) 328-6000
(228) 328-6035
Mailing address
14426 JAMES BOND RD, GULFPORT, MS 39503-8311
(228) 328-6000
(228) 328-6035
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
981
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04333899
—
MS
01
—
1013922954
NPI
MS
Enumeration date
01/09/2008
Last updated
12/05/2019
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