Provider Demographics
NPI:1316119217
Name:WARREN-WASHINGTON-ISSAQUENA-SHARKEY COMMUNITY ACTION AGENCY
Entity type:Organization
Organization Name:WARREN-WASHINGTON-ISSAQUENA-SHARKEY COMMUNITY ACTION AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-378-5857
Mailing Address - Street 1:1544 OLD LELAND RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-2656
Mailing Address - Country:US
Mailing Address - Phone:662-378-5857
Mailing Address - Fax:662-378-5859
Practice Address - Street 1:1544 OLD LELAND RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-2656
Practice Address - Country:US
Practice Address - Phone:662-378-5857
Practice Address - Fax:662-378-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770342Medicaid
MS00070527Medicaid