PREFERRED CARE DEVELOPMENTAL CENTERS OF MS I INC NPI 1659353688

NPI Information

NPI: 1659353688
Provider Name: PREFERRED CARE DEVELOPMENTAL CENTERS OF MS I INC

Doing Business As: CANTON MANOR

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

Address:
1145 TISDALE AVE
CANTON, MS
ZIP 39046
Phone: (601) 859-6712
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PREFERRED CARE DEVELOPMENTAL CENTERS OF MS I INC is an intermediate care facility mentally retarded in Canton, MS. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PREFERRED CARE DEVELOPMENTAL CENTERS OF MS I INC NPI is 1659353688. The provider is registered as an organization entity type.
The provider Is Doing Business As Canton Manor.

The provider's business location address is:

1145 TISDALE AVE
CANTON, MS
ZIP 39046-965
Phone: (601) 859-6712
Fax: (601) 859-2355

The provider's authorized official is Jamie Latture Collier .
The authorized official title is Director Of Reimbursement and has the following contact phone number (972) 931-3800.

The CLIA number assigned to this NPI record is 25D2214282 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/16/2005 and was last updated on 12/2/2014.

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
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		630	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	00220054	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: 4/28/2024

NPI Synchronization or Removal

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