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345 Edgewood Terrace Dr Jackson MS 39206-6217 | |
| (601) 738-5820 | |
| (601) 738-5083 |
| Full Name | |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 345 Edgewood Terrace Dr, Jackson, Mississippi |
| Authorized Official Name and Position | Timeka She'ree Wright (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6017385820 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
240 Johnstone Dr Madison MS 39110-7687 Ph: (601) 813-5878 | 345 Edgewood Terrace Dr Jackson MS 39206-6217 Ph: (601) 738-5820 |
| NPI Number | 1962163287 |
|---|---|
| Provider Enumeration Date | 01/08/2022 |
| Last Update Date | 04/28/2024 |
| Certification Date | 04/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962163287 | NPI | - | NPPES |
| 00424763 | Medicaid | MS |
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