PHC-CLEVELAND, INC. (NPI# 1538130414) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538130414 |
| Entity Type | Organization |
| Organization Name | PHC-CLEVELAND, INC. |
| Other Organization Name | BOLIVAR MEDICAL CENTER SKILLED NURSING UNIT |
| Practice Address |
901 E Sunflower Rd Cleveland MS 38732-2833 |
| Practice Telephone | 6628460061 |
| Practice Fax Number | 6628462380 |
| Mailing Telephone | 6628460061 |
| Mailing Fax Number | 6628462380 |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-10-03 |
| Authorized Official Name | WILLIAM M. GRACEY (COO) |
| Authorized Official Telephone | 6153728500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 151 | MS | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Bolivar Medical Center Skilled Nursing Unit | Doing Business As Name - Organization |
| Street Address |
901 E SUNFLOWER RD |
| City | CLEVELAND |
| State | MS |
| Zip Code | 38732-2833 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326032665 | Jack Bittell Sewell | Radiology | 901 E Sunflower Rd, Cleveland, MS 38732-2833 | 2005-09-01 |
| 1356733265 | G & G Health Services, LLC | Specialist | 901 E Sunflower Rd, Cleveland, MS 38732-2833 | 2015-03-02 |
| 1962822692 | Catherine Tanner Petzinger | Surgery | 901 E Sunflower Rd, Cleveland, MS 38732-2833 | 2014-04-21 |
| 1306142062 | Phc-cleveland Inc | Psychiatric Unit | 901 E Sunflower Rd, Cleveland, MS 38732-2833 | 2011-01-28 |
| 1770889461 | Phc-cleveland Inc | Medicare Defined Swing Bed Unit | 901 E Sunflower Rd, Cleveland, MS 38732-2833 | 2011-01-28 |
| 1194048231 | Delta Radiology Pllc | Radiology | 901 E Sunflower Rd, Cleveland, MS 38732-2833 | 2010-03-03 |
| 1952537938 | Nouveau Anesthesia Medical Group | Anesthesiology | 901 E Sunflower Rd, Cleveland, MS 38732-2833 | 2009-06-04 |
| 1396996997 | Acs Emergency Services of Mississippi Professional Association | Physician Assistant | 901 E Sunflower Rd, Cleveland, MS 38732-2833 | 2008-10-02 |
| 1891968327 | Edward Kofi Lartevi Md Pmc | Emergency Medicine | 901 E Sunflower Rd, Cleveland, MS 38732-2833 | 2008-04-04 |
| 1306916937 | Bolivar Pathology Services | Clinical Medical Laboratory | 901 E Sunflower Rd, 901 Hwy 8 East, Cleveland, MS 38732-2833 | 2006-11-09 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023629219 | Marilynn Pruitt | Technician | 108 Belvedere Court, Cleveland, MS 38732 | 2020-08-12 |
| 1417322587 | United Family Life Center | Clinic/Center | 1101 S Martin Luther King Drive, Cleveland, MS 38732 | 2015-12-01 |
| 1346661584 | Rebecca Winters | Speech-Language Pathologist | 4036 Hwy 8 East, Cleveland, MS 38732 | 2013-12-13 |
| 1982973186 | Delta Home Health Inc | Home Health | 300-b South Street, Cleveland, MS 38732 | 2011-12-19 |
| 1730467382 | Reid Farmer Davis Medico | Clinic/Center | 4080 Highway 8 West, Cleveland, MS 38732 | 2011-08-01 |
| 1700181427 | Sondra Speakes Huerta | Speech-Language Pathologist | 3939 Hwy 61 N. Suite 110, Cleveland, MS 38732 | 2011-01-12 |
| 1386956027 | Delta Soul Medical, LLC | Hospice Care, Community Based | 102 N. Pearman Ave., Ste. 1, Cleveland, MS 38732 | 2010-07-10 |
| 1700029675 | Jlrl, LLC | Dentist | 716 First Street, Cleveland, MS 38732 | 2009-04-08 |
| 1417194978 | Bolivar Emergency Group LLC | Physician Assistant | 901 Hwy 8 East Sunflower Rd, Cleveland, MS 38732 | 2009-01-20 |
| 1902055767 | Word of Deliverance Adult Day Care | Custodial Care Facility | 509 Davis Avenue, Cleveland, MS 38732 | 2008-09-16 |
| Find all providers in zip 38732 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700239894 | Tyler Joseph Gajdos | Skilled Nursing Facility | 4398 W 19th St, Cleveland, OH 44109-3638 | 2016-07-13 |
| 1720494495 | Tayler Cade | Skilled Nursing Facility | 1435 Clermont Rd, Cleveland, OH 44110-2806 | 2014-07-02 |
| 1619315884 | Genesis Rehab | Skilled Nursing Facility | 520 E 103rd St, Cleveland, OH 44108-1330 | 2013-06-11 |
| 1134306012 | Tri-med Pharmacy Services, LLC #3 | Skilled Nursing Facility | 2195 Varnell Rd Sw, Cleveland, TN 37311-7347 | 2008-01-23 |
| 1508057456 | Lp Cleveland LLC | Skilled Nursing Facility | 2750 Executive Park Nw, Cleveland, TN 37312-2722 | 2007-08-06 |
| 1770602435 | Dynamic Cleveland Operating Company LLC | Skilled Nursing Facility | 200 N Martin Luther King Dr, Cleveland, MS 38732-2821 | 2007-03-27 |
| 1396883591 | St Augustine Manor | Skilled Nursing Facility | 7801 Detroit Avenue, Cleveland, OH 44102 | 2007-02-01 |
| 1902958267 | Fairview Village Retirement Community, Ltd | Skilled Nursing Facility | 4110 Rocky River Dr, Cleveland, OH 44135-1175 | 2007-01-17 |
| 1376600098 | Hilo Medical Investors Ltd. | Skilled Nursing Facility | 3001 Keith St Nw, Cleveland, TN 37312-3713 | 2007-01-02 |
| 1891860656 | Cleveland Nursing and Rehabilitation Center, LLC | Skilled Nursing Facility | 4036 Highway 8 East, Cleveland, MS 38732 | 2006-11-21 |
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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.