| Ssipp Select Basketball & Mentoring Program Non Profit | |
|
3 Nottingham Cir Gulfport MS 39503-4021 | |
| (662) 519-1608 | |
| Not Available |
| Full Name | Ssipp Select Basketball & Mentoring Program Non Profit |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3 Nottingham Cir, Gulfport, Mississippi |
| Authorized Official Name and Position | Leonard C Bennett (DIRECTOR) |
| Authorized Official Contact | 6625191608 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssipp Select Basketball & Mentoring Program Non Profit 3 Nottingham Cir Gulfport MS 39503-4021 Ph: (662) 519-1608 | Ssipp Select Basketball & Mentoring Program Non Profit 3 Nottingham Cir Gulfport MS 39503-4021 Ph: (662) 519-1608 |
| NPI Number | 1396315792 |
|---|---|
| Provider Enumeration Date | 06/28/2021 |
| Last Update Date | 06/28/2021 |
| Certification Date | 06/27/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396315792 | NPI | - | NPPES |
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