Provider Demographics
NPI:1043958226
Name:RESTORATION CMHC PARTIAL HOSPITALIZATION PROGRAM, CORP
Entity type:Organization
Organization Name:RESTORATION CMHC PARTIAL HOSPITALIZATION PROGRAM, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-303-1800
Mailing Address - Street 1:308 CAMELLIA LN
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2604
Mailing Address - Country:US
Mailing Address - Phone:662-318-5018
Mailing Address - Fax:662-318-5018
Practice Address - Street 1:994 BANKHEAD DR
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3903
Practice Address - Country:US
Practice Address - Phone:662-318-5018
Practice Address - Fax:662-318-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)