Provider Demographics
NPI:1871131342
Name:NORTHEAST COMMUNITY SERVICES
Entity type:Organization
Organization Name:NORTHEAST COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-322-9963
Mailing Address - Street 1:126 CAITLYN DR
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-8102
Mailing Address - Country:US
Mailing Address - Phone:662-322-9963
Mailing Address - Fax:662-842-7972
Practice Address - Street 1:2847 HIGHWAY 178
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9606
Practice Address - Country:US
Practice Address - Phone:662-322-9963
Practice Address - Fax:662-842-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services