Provider Demographics
NPI:1639266588
Name:GOLDEN TRIANGLE PLANNING & DEVELOPMENT DISTRICT INC
Entity Type:Organization
Organization Name:GOLDEN TRIANGLE PLANNING & DEVELOPMENT DISTRICT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUPERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-324-7860
Mailing Address - Street 1:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-0828
Mailing Address - Country:US
Mailing Address - Phone:662-324-7860
Mailing Address - Fax:662-324-7328
Practice Address - Street 1:106 MILEY DRIVE
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-324-7860
Practice Address - Fax:662-324-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770410Medicaid