Provider Demographics
NPI:1710730924
Name:EAST MISSISSIPPI STATE HOSPITAL
Entity Type:Organization
Organization Name:EAST MISSISSIPPI STATE HOSPITAL
Other - Org Name:EMSH COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT PROGRAM DIRECTOR/BUSINESS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREEKMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-581-7919
Mailing Address - Street 1:1818 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-5721
Mailing Address - Country:US
Mailing Address - Phone:601-581-7880
Mailing Address - Fax:
Practice Address - Street 1:701 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-2361
Practice Address - Country:US
Practice Address - Phone:601-683-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST MISSISSIPPI STATE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness