Provider Demographics
NPI:1609589266
Name:NEW DIRECTION THERAPEUTIC GROUP HOME
Entity Type:Organization
Organization Name:NEW DIRECTION THERAPEUTIC GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-209-2717
Mailing Address - Street 1:5201 CEDAR PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4140
Mailing Address - Country:US
Mailing Address - Phone:601-982-1986
Mailing Address - Fax:601-982-1986
Practice Address - Street 1:362 E NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5456
Practice Address - Country:US
Practice Address - Phone:601-519-1731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty