Provider Demographics
NPI:1467998344
Name:MISSISSIPPI COMPREHENSIVE TREATMENT CENTERS, LLC
Entity Type:Organization
Organization Name:MISSISSIPPI COMPREHENSIVE TREATMENT CENTERS, LLC
Other - Org Name:GULF COAST COMPREHENSIVE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CTC DIVISION
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PELOQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:855-259-2288
Mailing Address - Street 1:6185 PASEO DEL NORTE STE 150
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1155
Mailing Address - Country:US
Mailing Address - Phone:855-259-2288
Mailing Address - Fax:
Practice Address - Street 1:14070 DEDEAUX RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4502
Practice Address - Country:US
Practice Address - Phone:877-533-5686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone