BRENT FONDSHAY BROOME (NPI# 1144548744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144548744 |
| Entity Type | Individual |
| Full Name | BRENT FONDSHAY BROOME |
| Credential | CNA |
| Practice Address |
6 David Patterson Rd Moselle MS 39459 |
| Mailing Address |
6 David Patterson Rd Moselle MS 39459-9439 |
| Practice Telephone | 6015963786 |
| Mailing Telephone | 6015963786 |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2010-05-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
A034616 | MS | Nursing & Custodial Care Facilities |
| N | 376K00000X | Nurse's Aide | A034616 | MS | Nursing Service Related Providers |
| Street Address |
6 DAVID PATTERSON RD |
| City | MOSELLE |
| State | MS |
| Zip Code | 39459 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841711546 | Mississippi Baptist Ministry for Children and Families Inc | Assisted Living Facility | 6 David Patterson Rd, Moselle, MS 39459-9439 | 2017-07-03 |
| 1649790031 | Mississippi Baptist Ministry for Children and Families Inc | Peer Specialist | 6 David Patterson Rd, Moselle, MS 39459-9439 | 2017-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548302094 | Ronald Elley Woodall | Internal Medicine | 283 Sellers Road, Moselle, MS 39459-9408 | 2007-02-13 |
| 1821402967 | Evelyn Rebecca Becky Wilson | Occupational Therapy Assistant | 710 Sellers Rd, Moselle, MS 39459-9419 | 2014-06-17 |
| 1457393217 | Roy White | Psychologist | 3 Clearview Cir, Moselle, MS 39459-9520 | 2006-06-12 |
| 1821503079 | Janice Baxter | Marriage & Family Therapist | 3 Clearview Cir, Moselle, MS 39459-9520 | 2017-12-11 |
| 1801313226 | Carol Brown | Counselor | 3 Clearview Cir, Moselle, MS 39459-9520 | 2017-08-25 |
| 1508389487 | Alayna Bryant | Counselor | 3 Clearview Cir, Moselle, MS 39459-9520 | 2017-07-21 |
| 1003339052 | Jessica Baxley | Marriage & Family Therapist | 3 Clearview Cir, Moselle, MS 39459-9520 | 2017-07-21 |
| 1568825479 | Christy Oberst | Counselor | 3 Clearview Cir, Moselle, MS 39459-9520 | 2016-03-30 |
| 1942576012 | Michael Kincade | Counselor | 3 Clearview Cir, Moselle, MS 39459-9520 | 2012-03-22 |
| 1982612206 | Region 12 Commission On Mental Health and Retardation | Substance Abuse Rehabilitation Facility | 3 Clearview Cir, Moselle, MS 39459-9520 | 2006-08-03 |
| Find all providers in zip 39459 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912540428 | Jennifer Lashon May | Custodial Care Facility | 141 Jefferson Street Ste, C, Monticello, MS 39654-3965 | 2019-10-28 |
| 1255866059 | Personal Touch LLC | Custodial Care Facility | 614 Chippewah Dr, Laurel, MS 39443-7413 | 2017-04-29 |
| 1164964003 | Creative Image Personal Care Service LLC | Custodial Care Facility | 503 Highway 82 E, Indianola, MS 38751-2317 | 2016-11-09 |
| 1679943310 | Educare Senior Day Center (vicksburg Branch) | Custodial Care Facility | 3202 Wisconsin Ave, Vicksburg, MS 39180-5351 | 2015-10-06 |
| 1659747988 | Aging Gracefully Community Center | Custodial Care Facility | 16165 Highway 51, Hazlehurst, MS 39083-2002 | 2015-08-20 |
| 1215315528 | Serenityhomecare | Custodial Care Facility | 1512 Clinton Raymond Rd, Clinton, MS 39056-5400 | 2015-05-07 |
| 1356765101 | Healthyland Adult Day Care, LLC | Custodial Care Facility | 227 Pecan Street, Marks, MS 38646 | 2014-02-14 |
| 1164845210 | R S Enterprise | Custodial Care Facility | 532 Burns St, Jackson, MS 39203-3601 | 2014-01-26 |
| 1053746487 | Assurance Home Care Agency LLC | Custodial Care Facility | 1549 Shiloh Church Rd, Newton, MS 39345-9024 | 2013-09-04 |
| 1790119519 | Pressicare, Inc | Custodial Care Facility | 20434 Old Houston Rd, Aberdeen, MS 39730-8548 | 2013-08-28 |
| Find all providers with the same taxonomy | ||||
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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.