| Center For Family Life Extensions, Inc. | |
|
1980 Highway 80 W Jackson MS 39204-2303 | |
| (601) 259-5745 | |
| (601) 871-8223 |
| Full Name | Center For Family Life Extensions, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1980 Highway 80 W, Jackson, Mississippi |
| Authorized Official Name and Position | Amanda Johnson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 0162595745 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Family Life Extensions, Inc. 1980 Highway 80 W Jackson MS 39204-2303 Ph: (601) 259-5745 | Center For Family Life Extensions, Inc. 1980 Highway 80 W Jackson MS 39204-2303 Ph: (601) 259-5745 |
| NPI Number | 1033454772 |
|---|---|
| Provider Enumeration Date | 12/06/2012 |
| Last Update Date | 03/22/2021 |
| Certification Date | 03/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033454772 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | M7862 (Mississippi) | Primary |
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