Provider Demographics
NPI:1407137086
Name:THE PHAROS INC.
Entity Type:Organization
Organization Name:THE PHAROS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIZMET
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-422-9877
Mailing Address - Street 1:300 SUNFLOWER RD APT 20
Mailing Address - Street 2:
Mailing Address - City:ITTA BENA
Mailing Address - State:MS
Mailing Address - Zip Code:38941-2730
Mailing Address - Country:US
Mailing Address - Phone:662-422-9877
Mailing Address - Fax:
Practice Address - Street 1:300 SUNFLOWER RD APT 20
Practice Address - Street 2:
Practice Address - City:ITTA BENA
Practice Address - State:MS
Practice Address - Zip Code:38941-2730
Practice Address - Country:US
Practice Address - Phone:662-422-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management