Provider Demographics
NPI:1790542454
Name:TUPELO CHILDREN'S MANSION, INC.
Entity Type:Organization
Organization Name:TUPELO CHILDREN'S MANSION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LMSW, LPC
Authorized Official - Phone:662-842-6982
Mailing Address - Street 1:1801 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-2934
Mailing Address - Country:US
Mailing Address - Phone:662-842-6982
Mailing Address - Fax:
Practice Address - Street 1:1801 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-2934
Practice Address - Country:US
Practice Address - Phone:662-842-6982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable