| Chase House Of Youth Restoration | |
|
394 W Oxford St Pontotoc MS 38863-1219 | |
| (662) 586-8081 | |
| Not Available |
| Full Name | Chase House Of Youth Restoration |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 394 W Oxford St, Pontotoc, Mississippi |
| Authorized Official Name and Position | Mason Todd Hester (DIRECTOR) |
| Authorized Official Contact | 6625868081 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chase House Of Youth Restoration 394 W Oxford St Pontotoc MS 38863-1219 Ph: (662) 586-8081 | Chase House Of Youth Restoration 394 W Oxford St Pontotoc MS 38863-1219 Ph: (662) 586-8081 |
| NPI Number | 1821827155 |
|---|---|
| Provider Enumeration Date | 07/26/2024 |
| Last Update Date | 11/14/2024 |
| Certification Date | 11/14/2024 |
| Medicare PECOS PAC ID | 1254862394 |
|---|---|
| Medicare Enrollment ID | O20241001001279 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821827155 | NPI | - | NPPES |
| Provider Name | Judy Palmer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932805298 PECOS PAC ID: 0941731095 Enrollment ID: I20241001001442 |
| Provider Name | Tina Renee Dye |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235250051 PECOS PAC ID: 5799217899 Enrollment ID: I20241014004700 |
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