SHANELL'S RESIDENTIAL CARE HOME, INC. (NPI# 1528359189) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528359189 |
| Entity Type | Organization |
| Organization Name | SHANELL'S RESIDENTIAL CARE HOME, INC. |
| Other Organization Name | SHANELL'S RESIDENTIAL CARE HOME, INC. (ASSISTANT LIVING) |
| Practice Address |
4022 California Ave Jackson MS 39213-5513 |
| Mailing Address |
Po Box 83040 Jackson MS 39283-3040 |
| Practice Telephone | 6013624549 |
| Mailing Telephone | 6013624549 |
| Mailing Fax Number | 6017133513 |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2011-04-29 |
| Authorized Official Name | MR. CARNELL KITCHENS (PRESIDENT) |
| Authorized Official Telephone | 6012594602 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 1035 | MS | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Shanell's Residential Care Home, Inc. (Assistant Living) | Doing Business As Name - Organization |
| Street Address |
4022 CALIFORNIA AVE |
| City | JACKSON |
| State | MS |
| Zip Code | 39213-5513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679117980 | Cynthia Bailey | Technician | 916 Carnation Street, Jackson, MS 39213 | 2019-10-30 |
| 1871136374 | Shirley Collins Williams | Technician | 3132 Sage St, Jackson, MS 39213 | 2019-10-28 |
| 1275057069 | Nikita Patel | Pharmacist | 830 West Woodrow Wilson Avenue, Jackson, MS 39213 | 2017-08-02 |
| 1346782893 | Mississippi Smiles Dentistry LLC | Dentist | 310 W Woodrow Wilson Ave, 400, Jackson, MS 39213 | 2016-11-15 |
| 1730637521 | Ms Eyecare Associates of Jackson, Pllc. | Optometrist | 310 West Woodrow Wilson Avenue Suite 300, Jackson, MS 39213 | 2016-09-21 |
| 1518410778 | Assurance Home Health Services, LLC | Health Maintenance Organization | 1771 Hamilton Blvd., Jackson, MS 39213 | 2016-07-25 |
| 1831576180 | Dorothy Jeffries Anderson | Counselor | 350 Woodrow Wilson Ave, Jackson, MS 39213 | 2015-05-06 |
| 1740697275 | Sincere Home Care LLC. | Chore Provider | 5911 Holmes Ct, Jackson, MS 39213 | 2014-07-16 |
| 1629401088 | Deborah Diane Wright | Assisted Living Facility | 5911 Holmes Court, Jackson, MS 39213 | 2013-08-20 |
| 1245663251 | Methodist Home Road Living Center | Licensed Practical Nurse | 4560 Methodist Home Road, Jackson, MS 39213 | 2013-08-13 |
| Find all providers in zip 39213 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598377905 | Nohc Jackson Senior Living LLC | Assisted Living Facility | N16744 Eagle Drive, Jackson, WI 53037 | 2020-08-18 |
| 1952924706 | Snh Se Tenant Trs, Inc | Assisted Living Facility | N168w22022 Main St, Jackson, WI 53037-9469 | 2020-05-27 |
| 1386124550 | Victorian Villa Assisted Living LLC | Assisted Living Facility | 5585 Brooklyn Rd South, Jackson, MI 49201-8570 | 2018-08-17 |
| 1215438585 | The Villas of Jackson LLC | Assisted Living Facility | 670 Broadridge, Jackson, MO 63755 | 2018-02-22 |
| 1912455361 | Victorious Healthcare L.L.C. | Assisted Living Facility | 4959 Laurel Oak Dr, Jackson, MS 39212-2150 | 2016-09-14 |
| 1265816433 | Open Arms Personal Care Home | Assisted Living Facility | 539 Claiborne Ave, Jackson, MS 39209-5340 | 2015-07-16 |
| 1629405121 | Ec Jackson Operations, LLC | Assisted Living Facility | 911 Old Humboldt Rd, Jackson, TN 38305-5668 | 2013-09-30 |
| 1629401088 | Deborah Diane Wright | Assisted Living Facility | 5911 Holmes Court, Jackson, MS 39213 | 2013-08-20 |
| 1740522135 | Harmony Court Assisted Living Home Inc | Assisted Living Facility | 5411 I 55 N, Jackson, MS 39206-3616 | 2013-03-23 |
| 1215225149 | House of Faith LLC | Assisted Living Facility | 928 Hunt St, Jackson, MS 39203-2908 | 2011-07-12 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on SHANELL'S RESIDENTIAL CARE HOME, 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.