Provider Demographics
NPI:1124465547
Name:CHRISTIAN SITTERS
Entity type:Organization
Organization Name:CHRISTIAN SITTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-982-2277
Mailing Address - Street 1:5538 N STATE ST
Mailing Address - Street 2:SUIT 106
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-3531
Mailing Address - Country:US
Mailing Address - Phone:601-982-2277
Mailing Address - Fax:601-982-2162
Practice Address - Street 1:5538 NORTH STATE STREET STE 106
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206
Practice Address - Country:US
Practice Address - Phone:601-982-2277
Practice Address - Fax:601-982-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08177766385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSBOBBIE BROWNOtherMEDICAID WAVIER