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COPAC INCORPORATED

Residential Treatment Facilities Substance Abuse Rehabilitation Facility

Provider NPI: 1922127331

Organization Information:
Organization Name:  COPAC INCORPORATED
Organization is not Subpart
Authorized Official:  JERALD STACY HUGHES, JR.  CEO  601-829-2500

Practice Location:
4309 LAKELAND DR  FLOWOOD, MS 39232-8947 US
Tel: 601-829-2500  Fax: 601-932-3857

Business Mailing Address:
4309 LAKELAND DR  FLOWOOD, MS 39232-8947 US
Tel: 601-829-2500  Fax: 601-932-3857

NPI Information:
NPI: 1922127331
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y324500000XResidential Treatment Facilities
Substance Abuse Rehabilitation Facility
MSFS39-DADA-OP-01

Other Provider Identifiers:

IssuerNumberStateType
PHYSICIAN1730289802MS01
NURSE PRACTITIONER1073679817MS01
PHYSICIAN1316016066MS01
0119422MS05
PHYSICIAN1801997127MS01
COPAC INCORPORATED1235270885MS01



American Medical Association 2012 taxonomy code information

Code: 324500000X

Type:

Classification:



Definition:



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