Provider Demographics
NPI:1720585888
Name:CLAIBORNE COUNTY HUMAN RESOURCE AGENCY
Entity Type:Organization
Organization Name:CLAIBORNE COUNTY HUMAN RESOURCE AGENCY
Other - Org Name:CLAIBORNE COUNTY PUBLIC TRANSIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-437-3063
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-0719
Mailing Address - Country:US
Mailing Address - Phone:601-437-3063
Mailing Address - Fax:601-437-2639
Practice Address - Street 1:1703 BRIDEWELL LN
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2809
Practice Address - Country:US
Practice Address - Phone:601-437-3063
Practice Address - Fax:601-437-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS8837Medicaid