NPIMap

Organization Active NPI

Region IV

  • Mental Illness Community Based Residential Treatment Facility
  • Batesville, MS
National Provider Identifier
1003243965
Registry record updated Oct 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
REGION IV
Practice address
120 Randy Hendrix Dr
Batesville, MS 38606-7664
Phone
(662) 563-9176
Fax
(662) 563-0269
NPI assigned
Oct 8, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lara James Hayes, M.ED
Title
Therapist
Phone
(662) 563-9176

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

120 Randy Hendrix Dr
Batesville, MS 38606-7664

Mailing address

120 Randy Hendrix Dr
Batesville, MS 38606-7664
Phone (662) 563-9176

Other identifiers 1

IdentifierTypeStateIssuer
1699869537MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Southaven Services31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381190400000",
    "number": "1003243965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 RANDY HENDRIX DR",
            "city": "BATESVILLE",
            "state": "MS",
            "postal_code": "386067664",
            "telephone_number": "662-563-9176",
            "fax_number": "662-563-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 RANDY HENDRIX DR",
            "city": "BATESVILLE",
            "state": "MS",
            "postal_code": "386067664",
            "telephone_number": "662-563-9176",
            "fax_number": "662-563-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGION IV",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-08",
        "last_updated": "2013-10-08",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "LARA",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "662-563-9176",
        "authorized_official_credential": "M.ED"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699869537",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Batesville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.