Provider Demographics
NPI:1982612206
Name:REGION 12 COMMISSION ON MENTAL HEALTH AND RETARDATION
Entity Type:Organization
Organization Name:REGION 12 COMMISSION ON MENTAL HEALTH AND RETARDATION
Other - Org Name:CLEARVIEW RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINACIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-544-4641
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1030
Mailing Address - Country:US
Mailing Address - Phone:601-544-7499
Mailing Address - Fax:601-584-4053
Practice Address - Street 1:3 CLEARVIEW CIR
Practice Address - Street 2:
Practice Address - City:MOSELLE
Practice Address - State:MS
Practice Address - Zip Code:39459-9520
Practice Address - Country:US
Practice Address - Phone:601-544-1499
Practice Address - Fax:601-584-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR12-DADA-PR-TR-OP-01324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018212Medicaid
MS20463OtherBC/BS PROVIDER NUMBER
MSC00097Medicare ID - Type Unspecified