Provider Demographics
NPI:1043536535
Name:HUDSPETH REGIONAL CENTER
Entity Type:Organization
Organization Name:HUDSPETH REGIONAL CENTER
Other - Org Name:HRC EIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS PAYABLE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-664-6049
Mailing Address - Street 1:PO BOX 127B
Mailing Address - Street 2:
Mailing Address - City:WHITFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39193-1032
Mailing Address - Country:US
Mailing Address - Phone:601-664-6049
Mailing Address - Fax:601-354-6945
Practice Address - Street 1:HIGHWAY 475 SOUTH
Practice Address - Street 2:
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193
Practice Address - Country:US
Practice Address - Phone:601-664-6049
Practice Address - Fax:601-354-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015377Medicaid