NISSI LLC (NPI# 1841755865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841755865 |
| Entity Type | Organization |
| Organization Name | NISSI LLC |
| Practice Address |
410 E First St Forest MS 39074-4204 |
| Practice Telephone | 6014694389 |
| Practice Fax Number | 6014694377 |
| Mailing Telephone | 6014694389 |
| Mailing Fax Number | 6014694377 |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2019-02-04 |
| Authorized Official Name | MR. AARON HINES (NURSE MANAGER) |
| Authorized Official Telephone | 6014694389 |
| Authorized Official Credential | LPN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Magnolia Manor | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | NISSI LLC | 900 Hendersonville Rd Suite 203, Asheville, NC 28803-1753 |
| Street Address |
410 E FIRST ST |
| City | FOREST |
| State | MS |
| Zip Code | 39074-4204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417127895 | Cottonwood Manor II | Assisted Living Facility | 410 E First St, Forest, MS 39074-4204 | 2008-03-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467095927 | Tamatha Nicole Owen | Nurse Practitioner | 1061 Highway 35 S, Forest, MS 39074 | 2019-10-28 |
| 1154687838 | Region Ten Commission On Mental Health | Clinic/Center | 13682 Hwy 80 West, Forest, MS 39074 | 2012-04-06 |
| 1053567636 | Cathy G Cooper | Physical Therapist | 813 West 3rd Street, Forest, MS 39074 | 2008-08-14 |
| 1487866158 | Terry Ann Meadows | Clinic/Center | 330 North Broad St, Forest, MS 39074 | 2007-05-04 |
| 1770702144 | Randy K Reynolds | Dentist | 208 West 3rd Street, Forest, MS 39074 | 2007-04-24 |
| 1215067293 | John B. Smith, Jr. Dmd, Pa | Dentist | 1040 Highway 35 South, Drawer 30, Forest, MS 39074 | 2007-03-07 |
| 1225189244 | Douglas F Harvel, Jr | Dentist | 1040 Highway 35 S, Forest, MS 39074 | 2007-01-16 |
| 1861542433 | Forest Dental Practice Pllc | Dentist | Po Drawer 30, Forest, MS 39074 | 2007-01-12 |
| 1306996970 | John B Smith Jr. | Dentist | 1040 Hwy 35 South, Forest, MS 39074 | 2007-01-12 |
| 1295821072 | Buddy Lee Eady | Chiropractor | 500 East 3rd St., Forest, MS 39074 | 2006-10-05 |
| Find all providers in zip 39074 | ||||
| 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 |
| 1831556331 | Falcon Crest Personal Care Assisted Living | Assisted Living Facility | 4 Falcon Ln, Hattiesburg, MS 39401-9350 | 2016-01-28 |
| 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 |
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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.