Provider Demographics
NPI:1609128339
Name:MY BROTHER'S KEEPER, INC
Entity Type:Organization
Organization Name:MY BROTHER'S KEEPER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-216-2455
Mailing Address - Street 1:805 E RIVER PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-3486
Mailing Address - Country:US
Mailing Address - Phone:601-500-7660
Mailing Address - Fax:769-243-7946
Practice Address - Street 1:805 E RIVER PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-3486
Practice Address - Country:US
Practice Address - Phone:601-500-7660
Practice Address - Fax:769-243-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center