MISSISSIPPI CHILDREN'S HOME SOCIETY (NPI# 1710366273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710366273 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI CHILDREN'S HOME SOCIETY |
| Practice Address |
1465 Lakeland Dr Jackson MS 39216-4719 |
| Practice Telephone | 6013527784 |
| Practice Fax Number | 6019680021 |
| Mailing Telephone | 6013527784 |
| Mailing Fax Number | 6019680021 |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2015-05-29 |
| Authorized Official Name | DR. JOHN D DAMON (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 6013527784 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Street Address |
1465 LAKELAND DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4719 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003982679 | Dennis Morgan Hydrick Jr. | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2006-11-27 |
| 1629638127 | Kiara Latrese Bass | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2019-06-17 |
| 1427510874 | Stephanie Moses | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2019-04-04 |
| 1063951416 | Heather Statham | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2017-02-17 |
| 1184075228 | Janie Mae Grant | Registered Nurse | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2016-06-30 |
| 1225498256 | Arin Adkins | Social Worker | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2016-03-03 |
| 1245616556 | Chrisitan Ware | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2015-08-10 |
| 1952780561 | Laura Moore | Registered Nurse | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2015-05-28 |
| 1922490853 | Ryan Dunlap | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2015-03-02 |
| 1265823181 | Brittany Spence | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2015-02-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558770842 | Therapeutic Alternatives | Residential Treatment Facility, Emotionally Disturbed Children | 593 Sergey Rd, Jackson, NJ 08527-4705 | 2014-08-12 |
| 1114291929 | Positive Living, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 3811 W Northside Dr, Jackson, MS 39209-2560 | 2012-02-27 |
| 1386916864 | Savior of Life Therapeutic Residential Group Home | Residential Treatment Facility, Emotionally Disturbed Children | 411 Naples Rd, Jackson, MS 39206-5918 | 2012-01-31 |
| 1568766905 | Saint Joshuas Therapeutic Group Home Inc | Residential Treatment Facility, Emotionally Disturbed Children | 3409 N State St, Jackson, MS 39216-3136 | 2010-12-28 |
| 1588973309 | Lamont Ingram Developmental Organization | Residential Treatment Facility, Emotionally Disturbed Children | 437 Riverside Dr, Jackson, TN 38301-5720 | 2010-09-28 |
| 1720123706 | Highfields | Residential Treatment Facility, Emotionally Disturbed Children | 1206 Clinton Rd, Jackson, MI 49202-2005 | 2007-02-20 |
| 1770901688 | Methodist Children's Homes | Residential Treatment Facility, Emotionally Disturbed Children | 805 N Flag Chapel Rd, Jackson, MS 39209-2208 | 2014-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184077364 | Pine Vale Children's Home | Residential Treatment Facility, Emotionally Disturbed Children | 1872 County Road 700, Corinth, MS 38834-8734 | 2016-07-22 |
| 1306292149 | Rehabilitation Centers LLC | Residential Treatment Facility, Emotionally Disturbed Children | 900 1st Ave Ne, Magee, MS 39111-3255 | 2016-05-11 |
| 1225324510 | Pine Vale Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1872 County Road 700, Corinth, MS 38834-8734 | 2011-06-24 |
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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.