Provider Demographics
NPI:1619313616
Name:TAKE1TOHELP1
Entity Type:Organization
Organization Name:TAKE1TOHELP1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAVON
Authorized Official - Middle Name:N
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-606-9472
Mailing Address - Street 1:806 MAXWELL DR APT 3
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-1128
Mailing Address - Country:US
Mailing Address - Phone:601-606-9472
Mailing Address - Fax:
Practice Address - Street 1:806 MAXWELL DR APT 3
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-1128
Practice Address - Country:US
Practice Address - Phone:601-606-9472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care