MISSISSIPPI STATE HOSPITAL (NPI# 1093994295) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093994295 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI STATE HOSPITAL |
| Other Organization Name | MISSISSIPPI STATE HOSPITAL CHEMICAL DEPENDENCY UNIT |
| Practice Address |
3550 Highway 468 W Whitfield MS 39193-5529 |
| Practice Telephone | 6013518000 |
| Mailing Telephone | 6013518000 |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2007-10-24 |
| Authorized Official Name | MR. JAMES G. CHASTAIN (DIRECTOR) |
| Authorized Official Telephone | 6013518000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Mississippi State Hospital Chemical Dependency Unit | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134366867 | Mississippi State Hospital | Clinic/Center | 350 Capers Ave, Jackson, MS 39203-2131 | 2009-01-16 |
| 1598750135 | Mississippi State Hospital | Pharmacy | 3550 Highway 468 W, Whitfield, MS 39193 | 2005-09-20 |
| 1467532903 | Mississippi State Hospital | Skilled Nursing Facility | 3550 Highway 468 W, Pearl, MS 39208-5529 | 2006-10-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MISSISSIPPI STATE HOSPITAL | 3550 State Hwy 468 W, Whitfield, MS 39193 |
| Street Address |
3550 HIGHWAY 468 W |
| City | WHITFIELD |
| State | MS |
| Zip Code | 39193-5529 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598750135 | Mississippi State Hospital | Pharmacy | 3550 Highway 468 W, Whitfield, MS 39193 | 2005-09-20 |
| 1124663190 | Jordan Reed | Nurse Practitioner | 3550 Highway 468 W, Whitfield, MS 39193-5529 | 2019-11-13 |
| 1427607688 | Chassity Nicole Vanderford | Nurse Practitioner | 3550 Highway 468 W, Whitfield, MS 39193-5529 | 2019-09-10 |
| 1528531985 | Ryane Plaster Doty | Nurse Practitioner | 3550 Highway 468 W, Whitfield, MS 39193-5529 | 2019-01-09 |
| 1750833984 | Clint Trest | Nurse Practitioner | 3550 Highway 468 W, Whitfield, MS 39193-5529 | 2016-11-04 |
| 1407209489 | Laura M Johnson | Nurse Practitioner | 3550 Highway 468 W, Whitfield, MS 39193-5529 | 2016-07-14 |
| 1871980995 | Billy Ray Walton | Nurse Practitioner | 3550 Highway 468 W, Whitfield, MS 39193-5529 | 2015-04-16 |
| 1699177634 | Shonna Pruitt Davis | Clinical Nurse Specialist | 3550 Highway 468 W, Whitfield, MS 39193-5529 | 2014-09-22 |
| 1407110554 | Chasity Lynne Torrence | Psychiatry & Neurology | 3550 Highway 468 W, Whitfield, MS 39193-5529 | 2012-07-03 |
| 1346511409 | Jenise Kohnke | Psychologist | 3550 Highway 468 W, Whitfield, MS 39193-5529 | 2012-01-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487150116 | Juletta Chisholm | Nurse Practitioner | 100 Hudspeth Center Dr, Whitfield, MS 39193 | 2018-04-02 |
| 1295014744 | Shazia Mulkana Frothingham | Psychologist | Building 51/psychological Services, Mississippi State Hospital, Whitfield, MS 39193 | 2011-08-15 |
| 1699803395 | Walter Robert Jones Jr. | Psychiatric Unit | Hwy 468, Hudspeth Regional Center, Whitfield, MS 39193 | 2007-03-02 |
| 1750448718 | Hudspeth Regional Center | Intermediate Care Facility, Mentally Retarded | Highway 475 South, Whitfield, MS 39193 | 2007-01-02 |
| 1447315411 | Hudspeth Center Pharmacy | Pharmacy | 100 Hudspeth Center Drive, Whitfield, MS 39193 | 2006-12-27 |
| 1346234184 | Hudspeth Center Pharmacy | Intermediate Care Facility, Mentally Retarded | Highway 475, Whitfield, MS 39193 | 2005-09-08 |
| 1598256018 | Katherine Willoughby Carter | Occupational Therapist | 157 Building #27, Whitfield, MS 39193 | 2018-05-21 |
| 1316377633 | Hudspeth Regional Center | Intermediate Care Facility, Mentally Retarded | 100 Hudspeth Center Drive, Whitfield, MS 39193 | 2013-11-22 |
| 1114210630 | Hudspeth Regional Center | Dentist | Highway 475 South, Whitfield, MS 39193 | 2011-05-17 |
| 1043536535 | Hudspeth Regional Center | Custodial Care Facility | Highway 475 South, Whitfield, MS 39193 | 2010-04-09 |
| Find all providers in zip 39193 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619585809 | Oxford Treatment Center, LLC | Substance Abuse Rehabilitation Facility | 616 Commerce Parkway, Oxford, MS 38655 | 2020-07-14 |
| 1861047250 | Defining Wellness Centers Inc. | Substance Abuse Rehabilitation Facility | 630 Lakeland East Dr Ste A, Flowood, MS 39232-9565 | 2019-08-03 |
| 1093284598 | Safe Harbor Recovery and Counseling LLC | Substance Abuse Rehabilitation Facility | 123 Westover Dr, Hattisburg, MS 39402-1329 | 2018-11-14 |
| 1164948196 | Extra Mile Recovery | Substance Abuse Rehabilitation Facility | 720 Oak Grove Rd, Mantachie, MS 38855-8469 | 2017-08-22 |
| 1891149738 | Stonewater Addiction Recovery Center | Substance Abuse Rehabilitation Facility | 38 County Road 362, Oxford, MS 38655-8514 | 2016-04-18 |
| 1386042471 | Recovery House, Inc. | Substance Abuse Rehabilitation Facility | 770 Golding Road, Columbus, MS 39704-2590 | 2014-12-05 |
| 1487067237 | Addiction Campuses of Mississippi, LLC | Substance Abuse Rehabilitation Facility | 7185 Swinnea Rd, Southaven, MS 38671-6003 | 2014-06-10 |
| 1518206440 | Alcohol Services Center, Inc. | Substance Abuse Rehabilitation Facility | 950 N West St, Jackson, MS 39202-2566 | 2013-02-13 |
| 1023373586 | Clever Recovery | Substance Abuse Rehabilitation Facility | 185 Foxtrail Rd, Picayune, MS 39466-9027 | 2012-07-11 |
| 1669603593 | Harbor Houses of Jackson, Inc. | Substance Abuse Rehabilitation Facility | 5354 I 55 S, Jackson, MS 39272-9119 | 2009-07-27 |
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| 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.