| Awakenings, Pa | |
|
12231 Ashley Dr Suite C Gulfport MS 39503-2775 | |
| (228) 831-9400 | |
| (228) 831-9600 |
| Full Name | Awakenings, Pa |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 12231 Ashley Dr, Gulfport, Mississippi |
| Authorized Official Name and Position | Anthony J Stock (OWNER) |
| Authorized Official Contact | 2288319400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Awakenings, Pa 12231 Ashley Dr Suite C Gulfport MS 39503-2775 Ph: (228) 831-9400 | Awakenings, Pa 12231 Ashley Dr Suite C Gulfport MS 39503-2775 Ph: (228) 831-9400 |
| NPI Number | 1639395197 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639395197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 13805 (Mississippi) | Primary |
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