Provider Demographics
NPI:1942591730
Name:WINTRIGG LLC
Entity Type:Organization
Organization Name:WINTRIGG LLC
Other - Org Name:RESTORATIVE AND BEHAVIORAL SERVICES OF JACKSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-233-8239
Mailing Address - Street 1:1307 AIRPORT RD N STE 2-B
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8897
Mailing Address - Country:US
Mailing Address - Phone:769-233-8239
Mailing Address - Fax:
Practice Address - Street 1:1307 AIRPORT RD N STE 2-B
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8897
Practice Address - Country:US
Practice Address - Phone:769-233-8239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health