Organization
CHRISTIAN FELLOWSHIP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRELL BERRY BOONE LPN (OWNER)
(601) 928-1871
Entity
Organization
Contact information
Practice address
918 PARKWAY DR, WIGGINS, MS 39577-8750
(601) 928-1871
Mailing address
918 PARKWAY DR, WIGGINS, MS 39577-8750
(601) 928-1871
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1063
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063
—
MS
Enumeration date
05/10/2012
Last updated
05/10/2012
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