Provider Demographics
NPI:1184767568
Name:COMMUNITY DEVELOPMENT INC.
Entity type:Organization
Organization Name:COMMUNITY DEVELOPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OMA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:HIBBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-788-5865
Mailing Address - Street 1:200 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:RICHTON
Mailing Address - State:MS
Mailing Address - Zip Code:39476-2201
Mailing Address - Country:US
Mailing Address - Phone:601-788-5865
Mailing Address - Fax:601-788-5722
Practice Address - Street 1:200 N FRONT ST
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476-2201
Practice Address - Country:US
Practice Address - Phone:601-788-5865
Practice Address - Fax:601-788-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770321Medicaid
MS00770364Medicaid
MS0770403Medicaid
MS00770494Medicaid