Provider Demographics
NPI:1306259981
Name:LOSE/CONTROL LLC
Entity type:Organization
Organization Name:LOSE/CONTROL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCELYN
Authorized Official - Middle Name:YOLANDA
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MPPA
Authorized Official - Phone:601-316-9989
Mailing Address - Street 1:PO BOX 6244
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39288-6244
Mailing Address - Country:US
Mailing Address - Phone:601-316-9989
Mailing Address - Fax:
Practice Address - Street 1:4795 I 55 N
Practice Address - Street 2:BUILDING B
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5602
Practice Address - Country:US
Practice Address - Phone:601-316-9989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251S00000X
MSR879573251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health