MISSISSIPPI COMPREHENSIVE TREATMENT CENTERS, LLC (NPI# 1467998344) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467998344 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI COMPREHENSIVE TREATMENT CENTERS, LLC |
| Other Organization Name | GULF COAST COMPREHENSIVE TREATMENT CENTER |
| Practice Address |
14070 Dedeaux Rd Gulfport MS 39503-4502 |
| Mailing Address |
6185 Paseo Del Norte Ste 150 Carlsbad CA 92011-1155 |
| Practice Telephone | 8775335686 |
| Mailing Telephone | 8552592288 |
| Enumeration Date | 2017-01-16 |
| Last Update Date | 2017-01-16 |
| Authorized Official Name | JOHN PELOQUIN (PRESIDENT, CTC DIVISION) |
| Authorized Official Telephone | 8552592288 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Gulf Coast Comprehensive Treatment Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629510540 | Mississippi Comprehensive Treatment Centers, LLC | Clinic/Center | 1935 Lakeland Dr Ste 900, Jackson, MS 39216-5028 | 2016-11-09 |
| Street Address |
14070 DEDEAUX RD |
| City | GULFPORT |
| State | MS |
| Zip Code | 39503-4502 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659466753 | Larry Ross Buntyn Sr. | Dentist | 14070 Dedeaux Rd, Gulfport, MS 39503-4502 | 2006-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013515451 | Gulf Coast Neurospa, LLC | Psychiatry & Neurology | 8845 Lorraine Road, Gulfport, MS 39503 | 2020-10-16 |
| 1447865985 | Nicholas Wyrosdick | Physical Therapist | 12261 Us 49 #1, Gulfport, MS 39503 | 2020-09-11 |
| 1750935169 | Ladner Roy Drugs, LLC. | Pharmacy | 12261 Us 49 Suite 16, Gulfport, MS 39503 | 2019-07-25 |
| 1528559440 | Alexander Therapy Services, LLC | Clinic/Center | 15465 Oak Ln Ste 100c, Gulfport, MS 39503 | 2018-05-25 |
| 1750879003 | Heather Lynn Theisen | Nurse Practitioner | 15190 Community Rd Ste 330, Gulfport, MS 39503 | 2018-04-23 |
| 1083101216 | Gulf Coast Mental Health Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15094 County Barn Road, Gulfport, MS 39503 | 2018-04-13 |
| 1306343173 | Dr. Raymond Monsour Scurfield, LLC | Community/Behavioral Health | 15465 Oak Lane Ste 100-g, Gulfport, MS 39503 | 2018-04-09 |
| 1952817157 | Mary Beth Welch | Behavioral Analyst | 9230 Old Lorraine Rd, Gulfport, MS 39503 | 2017-12-26 |
| 1831603257 | Beach View Family Dental, Pllc | Dentist | 9072 Lorraine Road, Gulfport, MS 39503 | 2017-11-21 |
| 1437677721 | Mary Stephens Ruffin | Social Worker | 11262 Creek Dr, Gulfport, MS 39503 | 2017-09-07 |
| Find all providers in zip 39503 | ||||
| Taxonomy Code | 261QM2800X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Methadone Clinic |
| An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861928541 | Metro Treatment of Mississippi Lp | Clinic/Center | 8900 Delta Bluffs Cove, Walls, MS 38680 | 2017-05-02 |
| 1124559976 | Metro Treatment of Mississippi, Lp | Clinic/Center | 1989 Pass Rd, Biloxi, MS 39531-4103 | 2017-03-23 |
| 1336688845 | Metro Treatment of Mississippi, Lp | Clinic/Center | 2419 10th St, Meridian, MS 39301-5040 | 2017-02-16 |
| 1629510540 | Mississippi Comprehensive Treatment Centers, LLC | Clinic/Center | 1935 Lakeland Dr Ste 900, Jackson, MS 39216-5028 | 2016-11-09 |
| 1164878419 | Ann Marshall | Clinic/Center | 2964 Terry Rd, Jackson, MS 39212-3055 | 2016-05-05 |
Please comment or provide details below to improve the information on MISSISSIPPI COMPREHENSIVE TREATMENT CENTERS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.