Provider Demographics
NPI:1982768388
Name:THREE RIVERS PLANNING & DEVELOPMENT DISTRICT
Entity type:Organization
Organization Name:THREE RIVERS PLANNING & DEVELOPMENT DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:R
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:662-489-2415
Mailing Address - Street 1:75 S MAIN ST
Mailing Address - Street 2:PO BOX 690
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-2914
Mailing Address - Country:US
Mailing Address - Phone:662-489-2415
Mailing Address - Fax:662-489-6815
Practice Address - Street 1:75 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-2914
Practice Address - Country:US
Practice Address - Phone:662-489-2415
Practice Address - Fax:662-489-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251B00000X, 332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770315Medicaid