Provider Demographics
NPI:1649288291
Name:CHILD ABUSE EDUCATION COUNCIL OF PEARL RIVER COUNTY, INC.
Entity type:Organization
Organization Name:CHILD ABUSE EDUCATION COUNCIL OF PEARL RIVER COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DELORIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:TATOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-799-5886
Mailing Address - Street 1:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-1789
Mailing Address - Country:US
Mailing Address - Phone:601-799-5886
Mailing Address - Fax:
Practice Address - Street 1:120 STREET A
Practice Address - Street 2:SUITE C
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-5466
Practice Address - Country:US
Practice Address - Phone:601-799-5886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015605Medicaid