Provider Demographics
NPI:1003582925
Name:MY BROTHER'S KEEPER, INC
Entity Type:Organization
Organization Name:MY BROTHER'S KEEPER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-216-2455
Mailing Address - Street 1:1221 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3506
Mailing Address - Country:US
Mailing Address - Phone:769-216-2455
Mailing Address - Fax:
Practice Address - Street 1:1221 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3506
Practice Address - Country:US
Practice Address - Phone:769-216-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY BROTHER'S KEEPER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center