Provider Demographics
NPI:1922262708
Name:CENTRAL MISSISSIPPI RESIDENTIAL CENTER
Entity Type:Organization
Organization Name:CENTRAL MISSISSIPPI RESIDENTIAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-683-4201
Mailing Address - Street 1:701 NORTHSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-0470
Mailing Address - Country:US
Mailing Address - Phone:601-683-4200
Mailing Address - Fax:601-683-4204
Practice Address - Street 1:701 NORTHSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-0470
Practice Address - Country:US
Practice Address - Phone:601-683-4200
Practice Address - Fax:601-683-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSDMH-CMRC (A)320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness