EXTENDICARE OF WEST TN (NPI# 1356606735) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356606735 |
| Entity Type | Organization |
| Organization Name | EXTENDICARE OF WEST TN |
| Practice Address |
250 N Parkway Suite 4 Jackson TN 38305-2735 |
| Mailing Address |
97 Thornfield Dr Bells TN 38006-5128 |
| Practice Telephone | 7316681372 |
| Practice Fax Number | 7316649919 |
| Mailing Telephone | 7316602171 |
| Mailing Fax Number | 7316602171 |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2012-07-11 |
| Authorized Official Name | MRS. SHELLEY DAWN KING (HYSICAL THERAPIST ASSISTANT) |
| Authorized Official Telephone | 7316602171 |
| Authorized Official Credential | PTA |
| Is Organization Subpart | Y |
| Parent Organization Name | LHC GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251C00000X | Day Training, Developmentally Disabled Services | 4019 | TN | Agencies |
| Y | 251E00000X | Home Health | 4019 | TN | Agencies |
| Street Address |
250 N PARKWAY SUITE 4 |
| City | JACKSON |
| State | TN |
| Zip Code | 38305-2735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477529964 | Wound Care Clinic Sd Inc | Nurse Practitioner | 250 N Parkway, Jackson, TN 38305-2735 | 2006-02-24 |
| 1881003606 | Terri Landry | Health Maintenance Organization | 250 N Parkway, Ste 4, Jackson, TN 38305-2735 | 2014-08-06 |
| 1760747166 | Shelley Dawn King | Physical Therapy Assistant | 250 N Parkway, Suite 4, Jackson, TN 38305-2735 | 2012-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427656818 | Kimaya Jelks | Specialist | 1869 45 Hwy Bypass, Suite 2b, Jackson, TN 38305 | 2020-10-16 |
| 1821600578 | Maame Obeng | Pharmacist | 3144 North Highland Avenue, Jackson, TN 38305 | 2020-08-22 |
| 1700361904 | James Cowie | Psychologist | 156c West University Pkwy, Jackson, TN 38305 | 2018-10-03 |
| 1700372109 | Chad Zawacki | Physician Assistant | 147 North Star Drive, Jackson, TN 38305 | 2018-07-09 |
| 1104323070 | Golden Years Adult Day Care | Clinic/Center | 155 Carriage Dr Suite A, Jackson, TN 38305 | 2018-04-09 |
| 1245754563 | Tanika Annette Gillard | Massage Therapist | 4 Hampton Ln, Jackson, TN 38305 | 2017-07-28 |
| 1316488117 | Lakisha T Ingram | Counselor | 168 Greencastle Dr, Jackson, TN 38305 | 2017-03-13 |
| 1619421567 | D & L Wellness Inc | Community/Behavioral Health | 154 Carriage House Dr., Jackson, TN 38305 | 2016-08-09 |
| 1649637638 | Advance Choice Home Care LLC | In Home Supportive Care | 1028 Ashport Rd., Jackson, TN 38305 | 2016-01-21 |
| 1942666151 | Neurohealth Solutions Inc. | Clinic/Center | 174 Murray Guard Dr. Suite E, Jackson, TN 38305 | 2016-01-05 |
| Find all providers in zip 38305 | ||||
| Taxonomy Code | 251E00000X |
| Grouping | Agencies |
| Classification | Home Health |
| A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |
| Notes: Source: CFR42 Chapter IV Part 484, http://www.access.gpo.gov/nara/cfr/waisidx_99/42cfr484_99.html [7/1/2007: definition added, source added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164029930 | Just Like Family Home Care LLC | Home Health | 910 E Northside Dr # 910e, Jackson, MS 39206-5533 | 2020-10-05 |
| 1235743162 | Shymeka Bolden | Home Health | 405 Dewitt Ave, Jackson, MS 39203 | 2020-09-08 |
| 1023647955 | Jennifer Mcneil | Home Health | 5814 Clinton Blvd # 2b, Jackson, MS 39209-2807 | 2020-04-02 |
| 1326670977 | Tyesha Smith | Home Health | 200 Rebel Woods Dr, Jackson, MS 39212-3009 | 2020-02-11 |
| 1780230185 | Avis Caring Hands Home Service | Home Health | 1419 Cooks Ave, Jackson, MS 39212-4376 | 2019-08-13 |
| 1063073500 | Dorothy Jean Homes | Home Health | 1836 First Ave, Jackson, MS 39209-6345 | 2019-06-25 |
| 1750941027 | Rock Care Home Health, LLC | Home Health | 3130 E Jackson Blvd Ste B, Jackson, MO 63755-2957 | 2019-06-18 |
| 1417415548 | Serenity Home Health Care | Home Health | 283 Parks Rd, Jackson, MS 39212-9604 | 2019-03-07 |
| 1841762192 | All About You Care LLC | Home Health | 716 Tomlinson St, Jackson, MI 49203-2060 | 2018-12-27 |
| 1013489483 | Sarah Gillum | Home Health | 1127 Greenbriar St, Jackson, MS 39211-2735 | 2018-12-26 |
| Find all providers in JACKSON | ||||
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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.