Provider Demographics
NPI:1043581614
Name:CENTRAL MS PLANNING & DEVELPMENT DISTRICT
Entity Type:Organization
Organization Name:CENTRAL MS PLANNING & DEVELPMENT DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:F
Authorized Official - Middle Name:CLARKE
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-981-1511
Mailing Address - Street 1:1170 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4701
Mailing Address - Country:US
Mailing Address - Phone:601-981-1511
Mailing Address - Fax:601-981-1515
Practice Address - Street 1:1170 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4701
Practice Address - Country:US
Practice Address - Phone:601-981-1511
Practice Address - Fax:601-981-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0770316251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0770316Medicaid