Provider Demographics
NPI:1386921500
Name:RANKIN BAPTIST ASSOCIATION
Entity type:Organization
Organization Name:RANKIN BAPTIST ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-939-6634
Mailing Address - Street 1:5611 HIGHWAY 80 E.
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208
Mailing Address - Country:US
Mailing Address - Phone:601-939-6634
Mailing Address - Fax:601-420-9252
Practice Address - Street 1:5611 HIGHWAY 80 E.
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208
Practice Address - Country:US
Practice Address - Phone:601-939-6634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANKIN BAPTIST ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty