FALCON CREST PERSONAL CARE ASSISTED LIVING (NPI# 1831556331) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831556331 |
| Entity Type | Organization |
| Organization Name | FALCON CREST PERSONAL CARE ASSISTED LIVING |
| Practice Address |
4 Falcon Ln Hattiesburg MS 39401-9350 |
| Practice Telephone | 6013364590 |
| Practice Fax Number | 6013364598 |
| Mailing Telephone | 6013364590 |
| Mailing Fax Number | 6013364598 |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2016-01-28 |
| Authorized Official Name | SUSAN M PARKER (ADMINISTRATOR) |
| Authorized Official Telephone | 6013364590 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
1092 | MS | Nursing & Custodial Care Facilities |
| Street Address |
4 FALCON LN |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-9350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679134183 | Sunset Residential Center LLC | Assisted Living Facility | 20114b Highway 18, Hermanville, MS 39086-9747 | 2019-06-25 |
| 1740756758 | Alfred Conway Porter | Assisted Living Facility | 3201 Hollywood Ave, Jackson, MS 39213-6754 | 2018-10-17 |
| 1427535491 | Carnell Kitchens | Assisted Living Facility | 585 E Beasley Rd, Jackson, MS 39206-3044 | 2018-07-23 |
| 1780096586 | Rest Haven | Assisted Living Facility | 686 County Road 370, Enterprise, MS 39330-9727 | 2014-05-28 |
| 1811232135 | Fondren Cove Relay, Inc. | Assisted Living Facility | 4520 N State St, Jackson, MS 39206-5307 | 2012-11-28 |
| 1376893842 | In Loving Arms LLC | Assisted Living Facility | 83 White Chapel Road, Carriere, MS 39426-8778 | 2012-09-12 |
| 1316227580 | Shirley's Assisted Living | Assisted Living Facility | 1000 Bb King Rd, Indianola, MS 38751-3606 | 2011-08-19 |
| 1841755865 | Nissi LLC | Assisted Living Facility | 410 E First St, Forest, MS 39074-4204 | 2019-02-04 |
| City | HATTIESBURG |
| Zip Code | 39401 |
Please comment or provide details below to improve the information on FALCON CREST PERSONAL CARE ASSISTED LIVING.
| 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.