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WILLOWOOD DEVELOPMENTAL CENTER NPI 1174991855


NPI Information

NPI: 1174991855
Provider Name: WILLOWOOD DEVELOPMENTAL CENTER
Classification: Day Training, Developmentally Disabled Services - 251C00000X
Entity Type: Organization

CLIA Number: 25D2267789

Address:
1635 BOLING ST
JACKSON, MS
ZIP 39213
Phone: (601) 366-0123
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WILLOWOOD DEVELOPMENTAL CENTER is a day training developmentally disabled services in Jackson, MS. The provider is these agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning. WILLOWOOD DEVELOPMENTAL CENTER NPI is 1174991855. The provider is registered as an organization entity type.

The provider's business location address is:

1635 BOLING ST
JACKSON, MS
ZIP 39213-418
Phone: (601) 366-0123
Fax: (601) 366-0149

The provider's authorized official is Curtis E. Alford .
The authorized official title is Executive Director and has the following contact phone number (601) 366-0123.

The CLIA number assigned to this NPI record is 25D2267789 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/11/2015 and was last updated on 9/11/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251C00000XDay Training, Developmentally Disabled ServicesWDC-PVS-WAC-DSA-01MISSISSIPPIYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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