SAMARITAN GARDEN PERSONAL CARE HOME NPI 1508991357

NPI Information

NPI: 1508991357
Provider Name: SAMARITAN GARDEN PERSONAL CARE HOME
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 25D2194273

Address:
2603 S GLOSTER ST
TUPELO, MS
ZIP 38801
Phone: (662) 566-9974
Get Directions

SAMARITAN GARDEN PERSONAL CARE HOME is an assisted living facility in Tupelo, MS. The provider is 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. SAMARITAN GARDEN PERSONAL CARE HOME NPI is 1508991357. The provider is registered as an organization entity type.

The provider's business location address is:

2603 S GLOSTER ST
TUPELO, MS
ZIP 38801-903
Phone: (662) 566-9974

The provider's authorized official is Lisa Pulliam Satterwhite .
The authorized official title is Administrator and has the following contact phone number (662) 566-9974.

The CLIA number assigned to this NPI record is 25D2194273 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/22/2007 and was last updated on 12/11/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		876	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00770422	MEDICAID	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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