EMMANUEL RIDGE OF LOUISVILLE MS INC (NPI# 1497144265) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497144265 |
| Entity Type | Organization |
| Organization Name | EMMANUEL RIDGE OF LOUISVILLE MS INC |
| Other Organization Name | ADULT DAY HEALTH SERVICES |
| Practice Address |
803 W Main St Louisville MS 39339-2539 |
| Mailing Address |
750 Boling St Suite H Jackson MS 39209-2652 |
| Practice Telephone | 6627055031 |
| Practice Fax Number | 6627055034 |
| Mailing Telephone | 7692337437 |
| Mailing Fax Number | 7692510257 |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2015-01-16 |
| Authorized Official Name | MS. BEATRICE A EZEM (CEO) |
| Authorized Official Telephone | 6019279839 |
| Authorized Official Credential | RN,CM,CLNC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WA2000X |
Registered Nurse Specialization: Administrator |
R815521 | MS | Nursing Service Providers |
| N | 253Z00000X | In Home Supportive Care | 03630719 | MS | Agencies |
| Y | 251T00000X | PACE Provider Organization | 08752218 | MS | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 08752218 | 05 |
| Other Name | Type Code |
|---|---|
| ADULT DAY HEALTH SERVICES | Doing Business As Name - Organization |
| Street Address |
803 W MAIN ST |
| City | LOUISVILLE |
| State | MS |
| Zip Code | 39339-2539 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962669614 | Jrs&j Adult Care Center, Inc | Assisted Living Facility | 803 W Main St, Louisville, MS 39339-2539 | 2008-05-20 |
| 1033508809 | Emmanuel Ridge Housing Inc | Custodial Care Facility | 803 W Main St, Louisville, MS 39339-2539 | 2015-01-17 |
| 1265741300 | Jrs&j Adult Care Center, Inc. | Custodial Care Facility | 803 W Main St, Louisville, MS 39339-2539 | 2010-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972149573 | Thomas Cefalu | Pharmacist | 16575 E Main St, Louisville, MS 39339 | 2019-11-19 |
| 1720506371 | Jennifer Marie Burns | Physical Therapist | 110 N Walmart Drive Suite F, Louisville, MS 39339 | 2017-09-05 |
| 1326409335 | Courtney Nicole Shaw | Speech-Language Pathologist | 316 Rocky Hill Road, Louisville, MS 39339 | 2016-03-18 |
| 1033598503 | Winston Medical Clinic LLC | Clinic/Center | 16569 W Main St, Louisville, MS 39339 | 2015-05-29 |
| 1689969735 | Adam C Byrd | Dermatology | 313 N Court Ave, Ummc Dermatology - Louisville Clinic, Louisville, MS 39339 | 2011-06-16 |
| 1356587208 | Louisville Healthcare LLC | Skilled Nursing Facility | 543 East Main Street, Louisville, MS 39339 | 2008-12-24 |
| 1699935908 | Stephen Eugene Hunter | Emergency Medicine | 100 Ellie Smith Rd, Louisville, MS 39339 | 2008-06-10 |
| 1669566279 | Southern Pharmaceutical Corporation | Durable Medical Equipment & Medical Supplies | 17220 E Main St Ste C, Louisville, MS 39339 | 2006-10-03 |
| 1184737017 | Louisville Eye Care | Optometrist | 500 North Church, Louisville, MS 39339 | 2006-08-16 |
| 1679583249 | Raymond John Orgler | Surgery | 547 E. Main St, Louisville, MS 39339 | 2006-08-08 |
| Find all providers in zip 39339 | ||||
| Taxonomy Code | 251T00000X |
| Grouping | Agencies |
| Classification | PACE Provider Organization |
| A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights. |
| Notes: Source: Centers for Medicare and Medicaid, PACE Fact Sheet http://www.cms.hhs.gov/PACE/Downloads/PACEFactSheet.pdf [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740626290 | Yolanda H. Jackson | PACE Provider Organization | 512 Thomas St., Boyle, MS 38730 | 2013-05-10 |
| 1417292137 | Family First Adult Daycare LLC | PACE Provider Organization | 112 Scotland Cir, Hattiesburg, MS 39401-8326 | 2012-12-06 |
| 1407118698 | G.h.c. Incorporated | PACE Provider Organization | 548 Rosemary Rd Ste C, Cleveland, MS 38732-2075 | 2012-06-13 |
| 1861836132 | Restorations Adult Daycare | PACE Provider Organization | 1766 Old Leland Rd, Greenville, MS 38703 | 2013-04-17 |
| 1225374903 | Parental Adult Daycare | PACE Provider Organization | 215 W Main St, Marks, MS 38646-1136 | 2012-12-27 |
| 1093071300 | Metroplex Center, LLC | PACE Provider Organization | 312 Green St, Hattiesburg, MS 39401-3758 | 2012-04-11 |
| City | LOUISVILLE |
| Zip Code | 39339 |
Please comment or provide details below to improve the information on EMMANUEL RIDGE OF LOUISVILLE MS INC.
| 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.