Organization
BAPTIST HOMES INC
Active
Other names
SON Valley
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM MCCORMACK (EXECUTIVE DIRECTOR)
(601) 859-2100
Entity
Organization
Contact information
Practice address
461 GOODLOE RD, CANTON, MS 39046-9740
(601) 859-2100
(601) 859-2105
Mailing address
PO BOX 406, CANTON, MS 39046-0406
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
SV-BIDD-SVLS-01
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01275306
—
MS
Enumeration date
10/17/2012
Last updated
10/17/2012
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