Provider Demographics
NPI:1952832263
Name:FACES AND VOICES OF RECOVERY MISSISSIPPI
Entity Type:Organization
Organization Name:FACES AND VOICES OF RECOVERY MISSISSIPPI
Other - Org Name:MISSISSIPPI RECOVERY COMMUNITY ORGANIZATION COLLABORATIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:SOCAIAL PSYCHOLOGIST
Authorized Official - Phone:601-455-7488
Mailing Address - Street 1:412 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3381
Mailing Address - Country:US
Mailing Address - Phone:601-455-7488
Mailing Address - Fax:
Practice Address - Street 1:412 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3381
Practice Address - Country:US
Practice Address - Phone:601-455-7488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251V00000X251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4216108360Medicaid
MS8360412610Medicare PIN
MS6104128360Medicare Oscar/Certification