IDEAL PROVIDER, LLC (NPI# 1013141357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013141357 |
| Entity Type | Organization |
| Organization Name | IDEAL PROVIDER, LLC |
| Practice Address |
8869 Centre St # 3 Southaven MS 38671-1725 |
| Mailing Address |
8869 Centre St Southaven MS 38671-1725 |
| Practice Telephone | 6623427023 |
| Practice Fax Number | 6623427089 |
| Mailing Telephone | 6623427023 |
| Mailing Fax Number | 6623427089 |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2009-05-13 |
| Authorized Official Name | NGOZI EDMUNDS (PRESIDENT) |
| Authorized Official Telephone | 6623427023 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| N | 282E00000X | Long Term Care Hospital | Hospitals | ||
| Y | 385H00000X | Respite Care | Respite Care Facility |
| Street Address |
8869 CENTRE ST # 3 |
| City | SOUTHAVEN |
| State | MS |
| Zip Code | 38671-1725 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285196196 | Emma Tinsley-bowles Long | Social Worker | 8786 Northcreek Blvd, Bldg 8 Apt 3, Southaven, MS 38671 | 2019-04-01 |
| 1851847586 | Tiffany Lashea Jones | Adult Companion | 8755 Millbranch Road, Southaven, MS 38671 | 2016-09-01 |
| 1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
| 1073983052 | Tara Burt | Physical Therapist | 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 | 2015-10-02 |
| 1295160463 | Ideal Community Care,llc | In Home Supportive Care | 8869 Centre Str #3, Southaven, MS 38671 | 2013-09-06 |
| 1578995692 | Gregory Charles Eakins Jr. | Optometrist | 338 Goodman Rd West, Southaven, MS 38671 | 2013-07-31 |
| 1295173169 | Erica R. Martin | Social Worker | 975 Swinnea Rdg Ste 3, Southaven, MS 38671 | 2013-06-12 |
| 1386918431 | Freds Stores of Tennessee Inc | Pharmacy | 710 Church Road, Southaven, MS 38671 | 2012-03-06 |
| 1740565613 | Mary Jeanette Scruggs | Pharmacist | 1011 Goodman Rd, Southaven, MS 38671 | 2011-10-11 |
| 1184919268 | First Pharmacy Services 5 | Pharmacy | 5185a Getwell Rd, Southaven, MS 38671 | 2011-06-16 |
| Find all providers in zip 38671 | ||||
| Taxonomy Code | 385H00000X |
| Grouping | Respite Care Facility |
| Classification | Respite Care |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790236867 | Tennessee Home Care | Respite Care | 4527 Aberton Dr, Southaven, MS 38672-7175 | 2016-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467050237 | Unified Home & Respite Care, LLC | Respite Care | 317 Highland Blvd Ste G, Natchez, MS 39120-4634 | 2020-10-14 |
| 1124636659 | Graceful Serenity LLC | Respite Care | 1440 Dunn Pease Rd, Raymond, MS 39154-8252 | 2020-07-21 |
| 1194342592 | Tashanda Chamberlin | Respite Care | 100 Hopper Ave, Dekalb, MS 39328 | 2020-07-01 |
| 1801412838 | Ycsc Gulf Coast Ms, LLC | Respite Care | 770 Water St Ste 428, Biloxi, MS 39530-4220 | 2020-06-25 |
| 1215552005 | Demetress Brent | Respite Care | 2941 Sheila Dr, Jackson, MS 39209-6125 | 2020-06-08 |
| 1912531427 | Magnolia Personal Care LLC | Respite Care | 69 Bo Stampley Rd, Fayette, MS 39069-4879 | 2020-02-24 |
| 1750935714 | La Respite, LLC | Respite Care | 701 Bowie Ln, Greenwood, MS 38930-5935 | 2019-07-29 |
| 1851944524 | Tracey Bernard Scurlock Jr. | Respite Care | 3747 Eureka Rd, Batesville, MS 38606-8064 | 2019-07-22 |
| 1295394377 | Divinity Community Living, Inc. | Respite Care | 405 Briarwood Dr Ste 108q, Jackson, MS 39206-3032 | 2019-06-11 |
| 1871062521 | Live, Laugh and Love Homecare Services | Respite Care | 604 Highway 80 W Ste Roffice1, Clinton, MS 39056-4108 | 2018-11-23 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on IDEAL PROVIDER, LLC.
| 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.