Provider Demographics
NPI:1891907093
Name:COMMUNITY FAMILY HEALTHCARE, INC
Entity Type:Organization
Organization Name:COMMUNITY FAMILY HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:LODEN
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:662-282-4197
Mailing Address - Street 1:285 IVIE LANE
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 IVIE LANE
Practice Address - Street 2:
Practice Address - City:MANTACHIE
Practice Address - State:MS
Practice Address - Zip Code:38855
Practice Address - Country:US
Practice Address - Phone:662-282-4197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016148Medicaid
MS02324272Medicaid
MS1720180979OtherNPI INDIVIDUAL #
MS1720180979OtherNPI INDIVIDUAL #