MAXINE DELORES HARRIS (NPI# 1417508110) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417508110 |
| Entity Type | Individual |
| Full Name | MAXINE DELORES HARRIS |
| Practice Address |
104 Martin Luther King Blvd Arcola MS 38722 |
| Mailing Address |
Po Box 383 Arcola MS 38722-0383 |
| Practice Telephone | 6628277500 |
| Practice Fax Number | 6628277347 |
| Mailing Telephone | 6623787962 |
| Mailing Fax Number | 6628277347 |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2019-09-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 1043 | MS | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023377611 | Maxine Rosemarie Harris | Custodial Care Facility | 220-08 109 Avenue, Queens Village, NY 11429 | 2012-05-16 |
| 1508093204 | Maxine Barbara Harris | Social Worker | 7044 Amherst Ave, 1f, Saint Louis, MO 63130-2330 | 2009-06-19 |
| Street Address |
104 MARTIN LUTHER KING BLVD |
| City | ARCOLA |
| State | MS |
| Zip Code | 38722 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356992978 | Destiny Manor | Assisted Living Facility | 104 Martin Luther King Blvd, Arcola, MS 38722 | 2019-09-25 |
| 1164702718 | Clifton Harris | Technician | 104 Martin Luther King Blvd, Arcola, MS 38722 | 2011-08-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922633924 | Delta Regional Medical Center | Clinic/Center | 108 Main Street, Arcola, MS 38722 | 2020-03-10 |
| 1841841210 | Delta Regional Medical Center | Family Medicine | 108 Main Street, Arcola, MS 38722 | 2019-09-26 |
| 1689070021 | Shelia Collins | Clinic/Center | 105 Deer Creek, Arcola, MS 38722-3239 | 2014-11-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144701749 | Tiffany Rachelle Shull | Physical Therapy Assistant | 909 Green Mill Rd, Arcola, IL 61910-3527 | 2018-08-22 |
| 1255824991 | Paige Pierce | Occupational Therapist | 422 E 4th South St, Arcola, IL 61910-2059 | 2018-06-07 |
| 1659820090 | Texas Community Ems LLC | Ambulance | 227 Manor Ave, Arcola, TX 77583-2724 | 2016-09-27 |
| 1104197599 | Whispering Pines Health Center, Inc. | Clinic/Center | 600 East C.r. 300 North, Arcola, IL 61910-3785 | 2012-01-18 |
| 1245562990 | Renata Michelle Taylor | Case Manager/Care Coordinator | 845 Davis, Arcola, TX 77583-2005 | 2010-02-05 |
| 1083858369 | Arcola Cusd#306 | Student in an Organized Health Care Education/Training Program | 351 W Washington St, Arcola, IL 61910-1120 | 2009-04-30 |
| 1073764213 | Petersen Health Care, Inc | Skilled Nursing Facility | 422 E 4th St S, Arcola, IL 61910-2059 | 2008-10-07 |
| 1548452014 | Tieasha Dukes | Home Health | 503 Rosen Ave, Arcola, TX 77583-2752 | 2007-08-17 |
| 1033315098 | Jessica Mai Ray | Physical Therapist | 548 E Springfield Rd, Arcola, IL 61910-1801 | 2007-06-26 |
| 1215152814 | Richard Keith Grove | Chiropractor | 253 W Springfield Rd, Arcola, IL 61910-1202 | 2007-04-17 |
| Find all providers in ARCOLA | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356992978 | Destiny Manor | Assisted Living Facility | 104 Martin Luther King Blvd, Arcola, MS 38722 | 2019-09-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215558747 | Waymaker Enterprises, LLC | Assisted Living Facility | 204 Bradfield Rd, Madison, MS 39110-7035 | 2020-05-06 |
| 1548819733 | Snh Omiss Tenant LLC | Assisted Living Facility | 1488 Belk Blvd, Oxford, MS 38655-5356 | 2019-09-10 |
| 1457900649 | Snh Omiss Tenant LLC | Assisted Living Facility | 108 Clarington Dr, Southaven, MS 38671-5640 | 2019-09-10 |
| 1972152619 | The Claiborne At Adelaide | Assisted Living Facility | 74 Claiborne Way, Starkville, MS 39759-8544 | 2019-09-05 |
| 1992369102 | James Wilson | Assisted Living Facility | 15986 W Main St, Louisville, MS 39339-2636 | 2019-04-24 |
| 1023519766 | The Blake At Oxford | Assisted Living Facility | 110 Ed Perry Blvd, Oxford, MS 38655-3452 | 2018-02-27 |
| 1194224873 | Barnes Crossing Retirement Community LLC | Assisted Living Facility | 1090 County Road 811, Saltillo, MS 38866-7304 | 2018-02-07 |
| 1649782202 | Garden Hill Assisted Living | Assisted Living Facility | 2082 Yorkville Rd E, Columbus, MS 39702-9406 | 2017-11-03 |
| 1891228581 | Magnolia Gardens Assisted Living | Assisted Living Facility | 303 East Ivy, Ellisville, MS 39437 | 2017-04-10 |
| 1912455361 | Victorious Healthcare L.L.C. | Assisted Living Facility | 4959 Laurel Oak Dr, Jackson, MS 39212-2150 | 2016-09-14 |
| Find all providers with the same taxonomy | ||||
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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.