Provider Demographics
NPI:1316377633
Name:HUDSPETH REGIONAL CENTER
Entity Type:Organization
Organization Name:HUDSPETH REGIONAL CENTER
Other - Org Name:DEVELOPMENTAL EVALUATIONAL TRAINING AND EDUCATIONAL CONSULTATIVE TEAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESCUDE'
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-664-2333
Mailing Address - Street 1:P.O. BOX 127B
Mailing Address - Street 2:
Mailing Address - City:WHITFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39193
Mailing Address - Country:US
Mailing Address - Phone:601-664-6320
Mailing Address - Fax:601-664-6325
Practice Address - Street 1:100 HUDSPETH CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193
Practice Address - Country:US
Practice Address - Phone:601-664-2333
Practice Address - Fax:601-664-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities