Provider Demographics
NPI:1710027164
Name:NORTH CENTRAL PLANNING AND DEVELOPMENT DISTRICT
Entity Type:Organization
Organization Name:NORTH CENTRAL PLANNING AND DEVELOPMENT DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:662-283-2675
Mailing Address - Street 1:711 S APPLEGATE ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-3002
Mailing Address - Country:US
Mailing Address - Phone:662-283-2675
Mailing Address - Fax:662-283-5875
Practice Address - Street 1:711 S APPLEGATE ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-3002
Practice Address - Country:US
Practice Address - Phone:662-283-2675
Practice Address - Fax:662-283-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0770310Medicaid