RECOVERY SPECIALISTS OF MID SOUTH, LLC (NPI# 1417599747) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417599747 |
| Entity Type | Organization |
| Organization Name | RECOVERY SPECIALISTS OF MID SOUTH, LLC |
| Practice Address |
164 W University Pkwy Jackson TN 38305-1621 |
| Mailing Address |
164 W University Pkwy Ste A Jackson TN 38305-1621 |
| Practice Telephone | 7312151135 |
| Practice Fax Number | 7314106156 |
| Mailing Telephone | 7312151135 |
| Mailing Fax Number | 7314106156 |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2019-10-08 |
| Authorized Official Name | ELIZABETH M COLE (DIRECTOR/COOWNER) |
| Authorized Official Telephone | 7312151135 |
| Authorized Official Credential | R.N |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 405300000X | Prevention Professional | Other Service Providers |
| Other Name | Type Code |
|---|---|
| Mid South Recovery | Doing Business As Name - Organization |
| Street Address |
164 W UNIVERSITY PKWY |
| City | JACKSON |
| State | TN |
| Zip Code | 38305-1621 |
| 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 | 405300000X |
| Grouping | Other Service Providers |
| Classification | Prevention Professional |
| Prevention Professionals work in programs aimed to address specific patient needs, such as suicide prevention, violence prevention, alcohol avoidance, drug avoidance, and tobacco prevention. The goal of the program is to reduce the risk of relapse, injury, or re-injury of the patient. Prevention Professionals work in a variety of settings and provide appropriate case management, mediation, referral, and mentorship services. Individuals complete prevention professionals training for the population of patients with whom they work. |
| Notes: Source: National Uniform Claim Committee, 2015 [1/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104456698 | Abigail Gamble | Prevention Professional | 2500 N State St, Jackson, MS 39216-4500 | 2020-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407388176 | First Class Therapy | Prevention Professional | 114 Faculty Hill Rd, Portland, TN 37148-4257 | 2017-03-31 |
| 1538605449 | Danielle Green | Prevention Professional | 1192 Flat Stone Dr, Gallatin, TN 37066-4668 | 2017-01-17 |
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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.