Basic Information
| Provider Information | |||||||||
| NPI: | 1962638791 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHOICES FOR CHILDREN AND FAMILY - FOREST HILL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6639 SULLIVAN RD | ||||||||
| Address2: | |||||||||
| City: | GREENWELL SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707393112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252610160 | ||||||||
| FaxNumber: | 2257758149 | ||||||||
| Practice Location | |||||||||
| Address1: | 2607 RAYMOND RD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392122252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257759800 | ||||||||
| FaxNumber: | 2257758149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2009 | ||||||||
| LastUpdateDate: | 04/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | AUSTIN | ||||||||
| AuthorizedOfficialFirstName: | ANNETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2252610160 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHOICES FOR CHILDREN AND FAMILY | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.