Provider Demographics
NPI:1962638791
Name:CHOICES FOR CHILDREN AND FAMILY - FOREST HILL
Entity type:Organization
Organization Name:CHOICES FOR CHILDREN AND FAMILY - FOREST HILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-261-0160
Mailing Address - Street 1:6639 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-3112
Mailing Address - Country:US
Mailing Address - Phone:225-261-0160
Mailing Address - Fax:225-775-8149
Practice Address - Street 1:2607 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-2252
Practice Address - Country:US
Practice Address - Phone:225-775-9800
Practice Address - Fax:225-775-8149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICES FOR CHILDREN AND FAMILY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-08
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service