Provider Demographics
NPI:1235738618
Name:360INC.
Entity Type:Organization
Organization Name:360INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KAI
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:DOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-275-1452
Mailing Address - Street 1:27 DUDLEY CV
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-6884
Mailing Address - Country:US
Mailing Address - Phone:662-838-2142
Mailing Address - Fax:
Practice Address - Street 1:8547 HIGHWAY 178
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611-9670
Practice Address - Country:US
Practice Address - Phone:901-275-1452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health