Provider Demographics
NPI:1275057275
Name:SOUTHERN FOUNDATION FOR HOMELESS CHILDREN
Entity Type:Organization
Organization Name:SOUTHERN FOUNDATION FOR HOMELESS CHILDREN
Other - Org Name:GRAY'S TRANSPORTATION AND HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMMUNICATION REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:LATANNYA
Authorized Official - Middle Name:CATRIECE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-722-3118
Mailing Address - Street 1:317 MARTIN LUTHER KING DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-320-6616
Mailing Address - Fax:662-320-6616
Practice Address - Street 1:317 MARTIN LUTHER KING DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-320-6616
Practice Address - Fax:662-320-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health