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1102 Rose Street Prentiss MS 39474 | |
(601) 792-4276 | |
(601) 792-2947 |
Full Name | |
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Speciality | Psychiatric Unit |
Location | 1102 Rose Street, Prentiss, Mississippi |
Authorized Official Name and Position | Gary Lee Mccall (CHIEF OPERATING OFFICER) |
Authorized Official Contact | 6017924276 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1288 Prentiss MS 39474-1288 Ph: (601) 792-4276 | 1102 Rose Street Prentiss MS 39474 Ph: (601) 792-4276 |
NPI Number | 1629107990 |
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Provider Enumeration Date | 03/05/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1629107990 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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273R00000X | Psychiatric Unit | 16-179 (Mississippi) | Primary |