Provider Demographics
NPI:1194199042
Name:THE ARC SOUTHEAST MISSISSIPPI
Entity Type:Organization
Organization Name:THE ARC SOUTHEAST MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-580-0636
Mailing Address - Street 1:PO BOX 18800
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-8800
Mailing Address - Country:US
Mailing Address - Phone:601-580-0636
Mailing Address - Fax:601-583-4251
Practice Address - Street 1:65 BONHOMIE RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8648
Practice Address - Country:US
Practice Address - Phone:601-583-4251
Practice Address - Fax:601-583-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child