Organization
SOUTH MISSISSIPPI REGIONAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOANNA WHALEY (BENEFIT SPECIALIST)
(228) 867-1348
Entity
Organization
Contact information
Practice address
1170 W RAILROAD ST, LONG BEACH, MS 39560-4106
(228) 867-1348
(228) 214-5563
Mailing address
1170 W RAILROAD ST, LONG BEACH, MS 39560-4106
(228) 867-1348
(228) 214-5563
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
311
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00770072
PROVIDER NUMBER
MS
Enumeration date
02/24/2010
Last updated
02/24/2010
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