Ideal Provider, LLC

Primary specialty

Respite CareTaxonomy code 385H00000X

Legal business name

IDEAL PROVIDER, LLC

Practice address

8869 Centre St # 3
Southaven, MS 38671-1725

Phone

(662) 342-7023

Fax

(662) 342-7089

NPI assigned

May 13, 2009

Organization subpart

No

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

Authorized official

Name

Ngozi Edmunds

Title

President

Phone

(662) 342-7023

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242172800000",
    "number": "1013141357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8869 CENTRE ST",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711725",
            "telephone_number": "662-342-7023",
            "fax_number": "662-342-7089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8869 CENTRE ST # 3",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711725",
            "telephone_number": "662-342-7023",
            "fax_number": "662-342-7089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL PROVIDER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-13",
        "last_updated": "2009-05-13",
        "status": "A",
        "authorized_official_last_name": "EDMUNDS",
        "authorized_official_first_name": "NGOZI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-342-7023"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Hutcheson, P-LPC
• Quentin Hutchinson, M.S., BCBA, LBA
• Victoria Hutchinson, BCBA
• Iac Diagnostic Screening Lab
• Ideal Community Care,LLC
• In Loving Care Home Care LLC
• Ashoka Ravi Varma Indukuri Venkata Madhava, MD
• Christopher Ingram
• Inspire Health and Wellness LLC
• Internal Medicine Group of the Midsouth PLLC

• Respite Care in Southaven, MS
• Providers in Southaven, MS by specialty
• Respite Care in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; 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.