METHODIST HOME ROAD ASSISTED LIVING NPI 1215341979

NPI Information

  • NPI: 1215341979
  • Provider Name: METHODIST HOME ROAD ASSISTED LIVING
  • Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
  • Entity Type: Organization
  • Address: 4560 METHODIST HOME RD
    JACKSON, MS
    ZIP 39213
  • Phone: (769) 257-7232

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NPI Details

METHODIST HOME ROAD ASSISTED LIVING is a community based residential treatment facility mental illness in Jackson, MS. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. METHODIST HOME ROAD ASSISTED LIVING NPI is 1215341979. The provider is registered as an organization entity type.

The provider's business location address is:

4560 METHODIST HOME RD
JACKSON, MS
ZIP 39213-201
Phone: (769) 257-7232
Fax: (769) 257-7745

The provider's authorized official is Kiara Lashae Johnson .
The authorized official title is Manager and has the following contact phone number (601) 918-6415.

The enumeration date for this NPI number is 6/19/2014 and was last updated on 6/19/2014.

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
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesNo
2320800000XCommunity Based Residential Treatment Facility, Mental IllnessYes

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: 11/21/2025

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