NPI 1013922954

Specialized Treatment Facility

Organisation Psychiatric Residential Treatment Facility Gulfport, MS

Practice location

Address: 14426 James Bond Rd, Gulfport, MS 39503-8311
Phone: (228) 328-6000
Fax: (228) 328-6035

Authorised official

Name: Shannon Y Bush
Title: Program Director
Phone: (228) 328-6000

Registered specialties

Psychiatric Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 323P00000X Licence 981 (MS)

Other Psychiatric Residential Treatment Facility providers in Mississippi →

Registry record

NPI: 1013922954
Entity type: Organization
NPI issued: 29 Jul 2006
Record last updated: 5 Dec 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.