Provider Demographics
NPI:1013781509
Name:SOUL SURVIVORS LLC
Entity Type:Organization
Organization Name:SOUL SURVIVORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYVETTA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-807-4715
Mailing Address - Street 1:109 MOUNT CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-2237
Mailing Address - Country:US
Mailing Address - Phone:601-807-4715
Mailing Address - Fax:
Practice Address - Street 1:109 MOUNT CARMEL DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-2237
Practice Address - Country:US
Practice Address - Phone:601-807-4715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals