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JACKSON FREE CLINIC

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Company Details

Name: JACKSON FREE CLINIC
Jurisdiction: MISSISSIPPI
Business Type: Non Profit Corporation
Status: Good Standing
Effective Date: 14 Nov 2001 (24 years ago)
Business ID: 742542
ZIP code: 39203
County: Hinds
State of Incorporation: MISSISSIPPI
Principal Office Address: 925 MARTIN LUTHER KING JR DRIVEJACKSON, MS 39203

Incorporator

Name Role Address
JOYCE OLUTADE Incorporator 2500 NORTH STATE STREET, P O BOX 9231, JACKSON, MS 39216

Agent

Name Role Address
BETH BURGESS Agent 2506 LAKELAND DR STE 401, FLOWOOD, MS 39232

Chief Financial Officer

Name Role Address
Qua'niya HEAD Chief Financial Officer 925 MARTIN LUTHER KING JR DRIVE, JACKSON, MS 39203

Treasurer

Name Role Address
Chanu CHERUKURI Treasurer 925 MARTIN LUTHER KING JR DRIVE, JACKSON, MS 39203

Director

Name Role Address
HARSHIN SANJANWALA Director 925 MARTIN LUTHER KING JR DRIVE, JACKSON, MS 39203
CHRIS GLASGOW Director 925 MARTIN LUTHER KING JR DRIVE, JACKSON, MS 39203
CAROLINE DOHERTY Director 925 MARTIN LUTHER KING JR DRIVE, JACKSON, MS 39203

Unique Entity ID

Unique Entity ID:
S7YND13ZHXH9
CAGE Code:
9NHA6
UEI Expiration Date:
2026-05-15

Business Information

Activation Date:
2025-05-16
Initial Registration Date:
2022-09-07

National Provider Identifier

NPI Number:
1851068324
Certification Date:
2022-06-21

Authorized Person:

Name:
HALI PETERSON
Role:
CHAIR OF THE BOARD
Phone:

Taxonomy:

Selected Taxonomy:
251V00000X - Voluntary or Charitable Agency
Is Primary:
Yes

Contacts:

Filings

Type Status Filed Date Description
Non-Profit Annual Report Filed 2025-04-15 Annual Report For JACKSON FREE CLINIC
Amendment Form Filed 2025-04-14 Amendment For JACKSON FREE CLINIC
Amendment Form Filed 2003-12-02 Amendment
See File Filed 2003-12-02 See File
See File Filed 2002-05-10 See File
See File Filed 2001-12-26 See File
Name Reservation Form Filed 2001-11-14 Name Reservation

USAspending Awards / Financial Assistance

Date:
2023-09-19
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION
Obligated Amount:
582000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

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Date of last update: 30 Jun 2025

Sources: Company Profile on Mississippi Secretary of State Website