METHODIST HOME ROAD ASSISTED LIVING (NPI# 1215341979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215341979 |
| Entity Type | Organization |
| Organization Name | METHODIST HOME ROAD ASSISTED LIVING |
| Practice Address |
4560 Methodist Home Rd Jackson MS 39213-4201 |
| Practice Telephone | 7692577232 |
| Practice Fax Number | 7692577745 |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-06-19 |
| Authorized Official Name | KIARA LASHAE JOHNSON (MANAGER) |
| Authorized Official Telephone | 6019186415 |
| 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 | Residential Treatment Facilities | ||
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
| Street Address |
4560 METHODIST HOME RD |
| City | JACKSON |
| State | MS |
| Zip Code | 39213-4201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134533896 | Kiara Lashae Johnson | Respite Care | 4560 Methodist Home Rd, Jackson, MS 39213-4201 | 2014-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679117980 | Cynthia Bailey | Technician | 916 Carnation Street, Jackson, MS 39213 | 2019-10-30 |
| 1871136374 | Shirley Collins Williams | Technician | 3132 Sage St, Jackson, MS 39213 | 2019-10-28 |
| 1275057069 | Nikita Patel | Pharmacist | 830 West Woodrow Wilson Avenue, Jackson, MS 39213 | 2017-08-02 |
| 1346782893 | Mississippi Smiles Dentistry LLC | Dentist | 310 W Woodrow Wilson Ave, 400, Jackson, MS 39213 | 2016-11-15 |
| 1730637521 | Ms Eyecare Associates of Jackson, Pllc. | Optometrist | 310 West Woodrow Wilson Avenue Suite 300, Jackson, MS 39213 | 2016-09-21 |
| 1518410778 | Assurance Home Health Services, LLC | Health Maintenance Organization | 1771 Hamilton Blvd., Jackson, MS 39213 | 2016-07-25 |
| 1831576180 | Dorothy Jeffries Anderson | Counselor | 350 Woodrow Wilson Ave, Jackson, MS 39213 | 2015-05-06 |
| 1740697275 | Sincere Home Care LLC. | Chore Provider | 5911 Holmes Ct, Jackson, MS 39213 | 2014-07-16 |
| 1629401088 | Deborah Diane Wright | Assisted Living Facility | 5911 Holmes Court, Jackson, MS 39213 | 2013-08-20 |
| 1245663251 | Methodist Home Road Living Center | Licensed Practical Nurse | 4560 Methodist Home Road, Jackson, MS 39213 | 2013-08-13 |
| Find all providers in zip 39213 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285134965 | Guardian Angel Homes LLC | Community Based Residential Treatment Facility, Mental Illness | 1038 Woodbridge St, Jackson, MI 49203-3112 | 2018-02-19 |
| 1821537259 | Open Arms | Community Based Residential Treatment Facility, Mental Illness | 2907 Glenderry St, Jackson, MS 39212-2722 | 2017-02-17 |
| 1316360449 | Middle Ms Access Corporation | Community Based Residential Treatment Facility, Mental Illness | 620 W Amite St, Jackson, MS 39203-2618 | 2014-01-24 |
| 1336224179 | Mississippi State Hospital At Whitfield | Community Based Residential Treatment Facility, Mental Illness | 350 Capers Avenue, Jackson, MS 39203 | 2006-10-26 |
| 1780873232 | Mississippi Children's Home Society - Mypac | Community Based Residential Treatment Facility, Mental Illness | 1900 N West St, Jackson, MS 39202-1033 | 2007-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144833575 | Embracing Hearts Healthcare | Community Based Residential Treatment Facility, Mental Illness | 1018 Emileigh Dr, Summit, MS 39666-4700 | 2020-08-25 |
| 1285157693 | Schylon Smith | Community Based Residential Treatment Facility, Mental Illness | 535 Holt Collier St, Greenville, MS 38701-3846 | 2017-07-18 |
| 1467646034 | Baptist Homes, Inc. | Community Based Residential Treatment Facility, Mental Illness | 461 Goodloe Rd, Canton, MS 39046 | 2007-08-28 |
| 1003243965 | Region Iv | Community Based Residential Treatment Facility, Mental Illness | 120 Randy Hendrix Dr, Batesville, MS 38606-7664 | 2013-10-08 |
| 1588091458 | Region Iv Mental Health Services | Community Based Residential Treatment Facility, Mental Illness | 120 Randy Hendrix Dr, Batesville, MS 38606-7664 | 2013-10-08 |
| 1922262708 | Central Mississippi Residential Center | Community Based Residential Treatment Facility, Mental Illness | 701 Northside Drive, Newton, MS 39345-0470 | 2008-07-11 |
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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.