Provider Demographics
NPI:1821827155
Name:CHASE HOUSE OF YOUTH RESTORATION
Entity type:Organization
Organization Name:CHASE HOUSE OF YOUTH RESTORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-586-8081
Mailing Address - Street 1:394 W OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-1219
Mailing Address - Country:US
Mailing Address - Phone:662-586-8081
Mailing Address - Fax:
Practice Address - Street 1:394 W OXFORD ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-1219
Practice Address - Country:US
Practice Address - Phone:662-586-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)