Cleveland PCH Residential Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

978 Issued in MS

Legal business name

CLEVELAND PCH RESIDENTIAL LIVING, LLC

Doing business as

Cleveland Personal Care Community

Practice address

800 Third Street
Cleveland, MS 38732

Phone

(662) 846-6160

Fax

(662) 846-6164

NPI assigned

Jan 16, 2007

Last updated

Dec 26, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Megan P Young

Title

Executive Director

Phone

(662) 846-6160

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cleveland Personal Care Community Doing business as

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198627200000",
    "number": "1023169158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 THIRD STREET",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "38732",
            "telephone_number": "662-846-6160",
            "fax_number": "662-846-6164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 THIRD STREET",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "38732",
            "telephone_number": "662-846-6160",
            "fax_number": "662-846-6164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEVELAND PCH RESIDENTIAL LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-12-26",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "662-846-6160",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08073094",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cleveland Personal Care Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Cleveland, MS
• Providers in Cleveland, MS by specialty
• Assisted Living Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; 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.