JACKSON VAMC


Address: 1500 Woodrow Wilson Ave, Jackson, MS 39216-5116
Phone: 6153553451

JACKSON VAMC (NPI# 1154784965) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1154784965
Entity Type Organization
Organization Name JACKSON VAMC
Other Organization Name JACKSON VA CARE SITE
Practice Address 1500 Woodrow Wilson Ave
Jackson
MS 39216-5116
Mailing Address Po Box 94497
Cleveland
OH 44101-4497
Practice Telephone 6153553451
Mailing Telephone 6153553451
Enumeration Date 2016-03-30
Last Update Date 2017-10-04
Authorized Official Name ERIN POTTER (NPI TEAM MEMBER)
Authorized Official Telephone 2023822579
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 323P00000X Psychiatric Residential Treatment Facility Residential Treatment Facilities

Other Provider/Organization Names

Other Name Type Code
JACKSON VA CARE SITE Other Name - Individual/Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1407303050 Jackson Vamc Clinic/Center 6522 Dogwood View Parkway, Suite F, Jackson, MS 39213-7858 2016-09-01
1841232097 Jackson Vamc Clinic/Center 405 W Adams St, Kosciusko, MS 39090-3617 2006-06-12
1043250418 Jackson Vamc Clinic/Center 1502 S Colorado St, Greenville, MS 38703-7219 2006-06-07
1669410288 Jackson Vamc Clinic/Center 2103 13th St, Meridian, MS 39301-4045 2006-06-04
1528006152 Jackson Vamc Clinic/Center 105 Northgate Rd, Suite 2, Natchez, MS 39120-9162 2006-06-04
1376598698 Jackson Vamc Clinic/Center 5003 Hardy Street, Tower B Suite 402, Hattiesburg, MS 39402-1331 2006-05-24
1295787364 Jackson Vamc Clinic/Center 824 Alabama St, Columbus, MS 39702-5436 2006-05-17
1922496280 Jackson Vamc Clinic/Center 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 2015-01-08
1467762120 Jackson Vamc Clinic/Center 1308 Harrison Ave, Mccomb, MS 39648-2830 2010-10-15
1992754543 Jackson Vamc General Acute Care Hospital 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 2006-05-10

Office Location

Street Address 1500 WOODROW WILSON AVE
City JACKSON
State MS
Zip Code 39216-5116

Providers in the same location

NPI Name Taxonomy Address Enumeration
1639272693 Charles Gerard Sherwood Ophthalmology 1500 Woodrow Wilson Ave, G. V. 'sonny' Montgomery Va Medical Center, Jackson, MS 39216 2006-09-06

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1861011553 Ashley Melancon Prewitt Registered Nurse St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 2020-04-13
1194353391 Brianna Arrington Student in an Organized Health Care Education/Training Program Med/ Peds, 2500 N. State St., Jackson, MS 39216 2020-04-01
1720616485 Roshina Khalid Khan Student in an Organized Health Care Education/Training Program Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 2020-03-30
1275183550 Amanda Lynn Morellato Dentist Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 2019-09-18
1396305553 Abhishek Chhabra Student in an Organized Health Care Education/Training Program Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 2019-06-19
1427615996 Hometown Diagnostics Clinical Medical Laboratory Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 2019-05-21
1346807773 Shukundala C Smith Behavior Technician New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 2019-05-21
1063901098 G Eli Howell Md Pllc Plastic Surgery 971 Lakeland Dr Ste 225, Jackson, MS 39216 2018-05-04
1588168132 Caleb Zumbro Student in an Organized Health Care Education/Training Program Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 2018-03-20
1639677230 Walgreen Co Pharmacy 971 Lakeland Dr Ste 101, Jackson, MS 39216 2018-01-29
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Taxonomy Information

Taxonomy Code 323P00000X
Grouping Residential Treatment Facilities
Classification Psychiatric Residential Treatment Facility

Taxonomy Definition

A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient’s surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary
Notes: Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306344478 Legacy Treatment Serivces, Inc. Psychiatric Residential Treatment Facility 417 Smithburg Ct, Jackson, NJ 08527-4444 2018-01-24
1447462395 Mississippi Children's Home Psychiatric Residential Treatment Facility 1801 N West St, Jackson, MS 39202-1032 2007-05-04
1467950543 Community Treatment Solutions Psychiatric Residential Treatment Facility 593 Sergey Rd, Jackson, NJ 08527-4705 2018-01-24
1083112155 Legacy Treatment Serivces, Inc. Psychiatric Residential Treatment Facility 411 Smithburg Ct, Jackson, NJ 08527-4444 2018-01-24
1699926386 Woodridge of Tennessee, LLC Psychiatric Residential Treatment Facility 49 Old Hickory Blvd, Jackson, TN 38305-4551 2008-10-01
1639382690 Cares Center Inc Psychiatric Residential Treatment Facility 402 Wesley Ave, Jackson, MS 39202 2007-05-07

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1265829584 Cares Center Inc Psychiatric Residential Treatment Facility 28281 Road 401, Saucier, MS 39574-7135 2015-04-24
1235301615 Saint Francis Community Services At Mississppi, Inc. Psychiatric Residential Treatment Facility 4021 Chicot St, Pascagoula, MS 39581-4327 2008-03-26
1487762076 Rehabilitation Centers, LLC Psychiatric Residential Treatment Facility 901 First Avenue N.e., Magee, MS 39111 2006-08-25
1255448775 Rehabilitation Centers, LLC Psychiatric Residential Treatment Facility 1814 Hwy 15 North, Pontotoc, MS 38863 2006-08-23
1013922954 Specialized Treatment Facility Psychiatric Residential Treatment Facility 14426 James Bond Rd, Gulfport, MS 39503-8311 2006-07-29
1558504407 Parkwood Behavioral Health System Psychiatric Residential Treatment Facility 8135 Goodman Rd, Olive Branch, MS 38654-2103 2009-04-08
1467637488 Specialized Treatment Facility Psychiatric Residential Treatment Facility 14426 James Bond Rd, Gulfport, MS 39503-8311 2008-01-09
1144421496 Millcreek Schools, LLC Psychiatric Residential Treatment Facility 1814 Hwy 15 North, Pontotoc, MS 38863 2007-05-31
1932232931 Alliance Health Center, Inc. Psychiatric Residential Treatment Facility 5000 Highway 39 N, Meridian, MS 39301-1021 2007-03-13
1659404572 Diamond Grove Center Psychiatric Residential Treatment Facility 2311 Highway 15 S, Louisville, MS 39339-7071 2007-03-13
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Competitor

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City JACKSON
Zip Code 39216

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Dataset Information

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.

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