FONDREN COVE RELAY, INC. (NPI# 1811232135) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811232135 |
| Entity Type | Organization |
| Organization Name | FONDREN COVE RELAY, INC. |
| Other Organization Name | FONDREN COVE ASSITED LIVING |
| Practice Address |
4520 N State St Jackson MS 39206-5307 |
| Mailing Address |
Po Box 55861 Jackson MS 39296-5861 |
| Practice Telephone | 6019813945 |
| Mailing Telephone | 6019813945 |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2012-11-28 |
| Authorized Official Name | MR. CAMMIE E KITCHENS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6019813945 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Fondren Cove Assited Living | Doing Business As Name - Organization |
| Street Address |
4520 N STATE ST |
| City | JACKSON |
| State | MS |
| Zip Code | 39206-5307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083158406 | Optimum Personal Care & Sitters | Home Health | 4520 N State St, Jackson, MS 39206-5307 | 2016-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023661824 | Latoya Lanette Trunell | Occupational Therapy Assistant | 787 East Northside Drive, Jackson, MS 39206 | 2019-07-20 |
| 1649839291 | Andrew Harris | Dentist | 4505 I-55 Frontage Rd. N, Jackson, MS 39206 | 2019-06-07 |
| 1679065916 | Savannah Lee Zachry | Physical Therapist | 5140 Galaxie Dr Ste 108, Jackson, MS 39206 | 2018-06-02 |
| 1669987723 | Harmony House Calls LLC | Nurse Practitioner | 5140 Galaxie Dr Ste 105, Jackson, MS 39206 | 2017-12-11 |
| 1841719903 | Yolanda Yvette Bell | Nurse Practitioner | 6064 Whitestone Rd, Jackson, MS 39206 | 2017-09-10 |
| 1760907117 | Anthony Brown Jr. | Physical Therapist | 5411 I-55 North, Jackson, MS 39206 | 2017-08-07 |
| 1114457132 | Ambric N Williams | Occupational Therapy Assistant | 6017 Whitestone Rd, Jackson, MS 39206 | 2017-06-13 |
| 1952835613 | Peak Chiropractic Care, LLC | Chiropractor | 4915 I-55 North, Suite 201b, Jackson, MS 39206 | 2017-04-19 |
| 1447798293 | Peterkin and Associates of Mississippi Inc | Community/Behavioral Health | 5155 Galaxie Drive, Suite F, Jackson, MS 39206 | 2017-02-01 |
| 1952844219 | Jennifer Penick | Counselor | 460 Briarwood Drive, Suite 510, Jackson, MS 39206 | 2016-11-18 |
| Find all providers in zip 39206 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740756758 | Alfred Conway Porter | Assisted Living Facility | 3201 Hollywood Ave, Jackson, MS 39213-6754 | 2018-10-17 |
| 1427535491 | Carnell Kitchens | Assisted Living Facility | 585 E Beasley Rd, Jackson, MS 39206-3044 | 2018-07-23 |
| 1821337866 | Leann Care LLC | Assisted Living Facility | 33 Rawlig Wood Cove Ave, Jackson, TN 38305 | 2013-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679134183 | Sunset Residential Center LLC | Assisted Living Facility | 20114b Highway 18, Hermanville, MS 39086-9747 | 2019-06-25 |
| 1831556331 | Falcon Crest Personal Care Assisted Living | Assisted Living Facility | 4 Falcon Ln, Hattiesburg, MS 39401-9350 | 2016-01-28 |
| 1780096586 | Rest Haven | Assisted Living Facility | 686 County Road 370, Enterprise, MS 39330-9727 | 2014-05-28 |
| 1376893842 | In Loving Arms LLC | Assisted Living Facility | 83 White Chapel Road, Carriere, MS 39426-8778 | 2012-09-12 |
| 1316227580 | Shirley's Assisted Living | Assisted Living Facility | 1000 Bb King Rd, Indianola, MS 38751-3606 | 2011-08-19 |
| 1841755865 | Nissi LLC | Assisted Living Facility | 410 E First St, Forest, MS 39074-4204 | 2019-02-04 |
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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.