1558499806 NPI number — PLEASANT LIVING CARE COORDINATION

Table of content: (NPI 1558499806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558499806 NPI number — PLEASANT LIVING CARE COORDINATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLEASANT LIVING CARE COORDINATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558499806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5185 SEDGWICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39211-4808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-966-1820
Provider Business Mailing Address Fax Number:
601-206-1407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5185 SEDGWICK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39211-4808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-966-1820
Provider Business Practice Location Address Fax Number:
601-206-1407
Provider Enumeration Date:
03/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROSA
Authorized Official First Name:
TAMIKIA
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
601-966-1820

Provider Taxonomy Codes

  • Taxonomy code: 347C00000X , with the licence number:  07828705 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X , with the licence number: 07556060 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385H00000X , with the licence number: 01682361 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01682361 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07556060 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07828705 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".