Provider Demographics
NPI:1801128277
Name:REGION IV WORK ACTIVITY
Entity type:Organization
Organization Name:REGION IV WORK ACTIVITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUITIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:662-286-9883
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-0216
Mailing Address - Country:US
Mailing Address - Phone:662-837-4245
Mailing Address - Fax:662-837-9462
Practice Address - Street 1:800 COUNTY ROAD 564
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-7434
Practice Address - Country:US
Practice Address - Phone:662-837-4245
Practice Address - Fax:662-837-9462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGION IV MENTAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health