Provider Demographics
NPI:1326445057
Name:MISSISSIPPI CHRISTIAN FAMILY SERVICES INC.
Entity Type:Organization
Organization Name:MISSISSIPPI CHRISTIAN FAMILY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TILGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MBA
Authorized Official - Phone:662-873-9055
Mailing Address - Street 1:117 DELTA ST
Mailing Address - Street 2:
Mailing Address - City:ROLLING FORK
Mailing Address - State:MS
Mailing Address - Zip Code:39159-2266
Mailing Address - Country:US
Mailing Address - Phone:662-873-9055
Mailing Address - Fax:662-873-9079
Practice Address - Street 1:314 PINE STREET
Practice Address - Street 2:
Practice Address - City:ROLLING FORK
Practice Address - State:MS
Practice Address - Zip Code:39159
Practice Address - Country:US
Practice Address - Phone:662-873-4842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00770097251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0070097Medicaid