CENTER FOR FAMILY LIFE EXTENSION, INC. (NPI# 1053682724) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053682724 |
| Entity Type | Organization |
| Organization Name | CENTER FOR FAMILY LIFE EXTENSION, INC. |
| Practice Address |
1160 Mclean St Jackson MS 39209-7251 |
| Practice Telephone | 6013549948 |
| Practice Fax Number | 6013545239 |
| Mailing Telephone | 6013549948 |
| Mailing Fax Number | 6013545239 |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2012-01-26 |
| Authorized Official Name | ELMINA JOHNSON (COO) |
| Authorized Official Telephone | 6013549948 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | CYS-CFL-TGH-01 | MS | Residential Treatment Facilities |
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | CYS-CFL-TGH-01 | MS | Residential Treatment Facilities |
| Street Address |
1160 MCLEAN ST |
| City | JACKSON |
| State | MS |
| Zip Code | 39209-7251 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033454772 | Center for Family Life Extensions | Community/Behavioral Health | 1160 Mclean St, Jackson, MS 39209-7251 | 2012-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235754995 | Oak Street Health Physicians Group of Mississippi, LLC | Family Medicine | 911 Ellis Ave, Jackson, MS 39209 | 2020-06-09 |
| 1760003594 | Phi Health, LLC | Ambulance | 582 Ramp Road, Suite C, Jackson, MS 39209 | 2020-05-04 |
| 1720468911 | Genoa Healthcare, LLC | Pharmacy | 3450 Highway 80 W Rm 68, Jackson, MS 39209 | 2015-06-03 |
| 1013302082 | Tiffany Griffin | Nurse Practitioner | 3450 Highway 80 West, Jackson, MS 39209 | 2015-04-06 |
| 1679961957 | Cassetta Shontae Mcgee | Emergency Medical Technician, Basic | 5326 Queen Eleanor Ln, Jackson, MS 39209 | 2015-01-08 |
| 1124381280 | Martin Solution | In Home Supportive Care | 917 West Ridge, Jackson, MS 39209 | 2012-06-22 |
| 1649533589 | Adrinnie M Martin | Contractor | 917 Westridge, Jackson, MS 39209 | 2012-06-15 |
| 1831423862 | Infinity House, Inc | In Home Supportive Care | 1042 Pecan Park Circle, Jackson, MS 39209 | 2009-09-23 |
| 1174751093 | Linda M Vance | Nurse Practitioner | 1000 Metrocenter Ste 105, Jackson, MS 39209 | 2009-06-30 |
| 1770729998 | Kim Hestle | Speech-Language Pathologist | 733 N. Flag Chapel Road, Jackson, MS 39209 | 2008-12-17 |
| Find all providers in zip 39209 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558770842 | Therapeutic Alternatives | Residential Treatment Facility, Emotionally Disturbed Children | 593 Sergey Rd, Jackson, NJ 08527-4705 | 2014-08-12 |
| 1114291929 | Positive Living, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 3811 W Northside Dr, Jackson, MS 39209-2560 | 2012-02-27 |
| 1386916864 | Savior of Life Therapeutic Residential Group Home | Residential Treatment Facility, Emotionally Disturbed Children | 411 Naples Rd, Jackson, MS 39206-5918 | 2012-01-31 |
| 1568766905 | Saint Joshuas Therapeutic Group Home Inc | Residential Treatment Facility, Emotionally Disturbed Children | 3409 N State St, Jackson, MS 39216-3136 | 2010-12-28 |
| 1588973309 | Lamont Ingram Developmental Organization | Residential Treatment Facility, Emotionally Disturbed Children | 437 Riverside Dr, Jackson, TN 38301-5720 | 2010-09-28 |
| 1720123706 | Highfields | Residential Treatment Facility, Emotionally Disturbed Children | 1206 Clinton Rd, Jackson, MI 49202-2005 | 2007-02-20 |
| 1710366273 | Mississippi Children's Home Society | Residential Treatment Facility, Emotionally Disturbed Children | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2015-05-29 |
| 1770901688 | Methodist Children's Homes | Residential Treatment Facility, Emotionally Disturbed Children | 805 N Flag Chapel Rd, Jackson, MS 39209-2208 | 2014-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184077364 | Pine Vale Children's Home | Residential Treatment Facility, Emotionally Disturbed Children | 1872 County Road 700, Corinth, MS 38834-8734 | 2016-07-22 |
| 1306292149 | Rehabilitation Centers LLC | Residential Treatment Facility, Emotionally Disturbed Children | 900 1st Ave Ne, Magee, MS 39111-3255 | 2016-05-11 |
| 1225324510 | Pine Vale Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1872 County Road 700, Corinth, MS 38834-8734 | 2011-06-24 |
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| 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.