Emmanuel Ridge Housing Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EMMANUEL RIDGE HOUSING INC

Doing business as

ASSISTED/EXTENDED STAY FACILITY

Practice address

803 W Main St
Louisville, MS 39339-2539

Phone

(662) 705-5031

Fax

(662) 705-5034

NPI assigned

Jan 17, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Beatrice A Ezem, RN,CM,CLNC

Title

Ceo

Phone

(601) 927-9839

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• ASSISTED/EXTENDED STAY FACILITY Doing business as

Locations

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

{
    "created_epoch": "1421452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421452800000",
    "number": "1033508809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 BOLING ST",
            "address_2": "SUITE H",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392092652",
            "telephone_number": "769-233-7439",
            "fax_number": "769-251-0257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 W MAIN ST",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393392539",
            "telephone_number": "662-705-5031",
            "fax_number": "662-705-5034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMMANUEL RIDGE HOUSING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-17",
        "last_updated": "2015-01-17",
        "status": "A",
        "authorized_official_last_name": "EZEM",
        "authorized_official_first_name": "BEATRICE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-927-9839",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN,CM,CLNC"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MS",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08762218",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03630719",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07123515",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASSISTED/EXTENDED STAY FACILITY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Angela K Elmshaeuser, DPT
• Emergency Room MD LLC
• Emergency Room MD LLC
• Emmanuel Ridge of Louisville Ms Inc
• Barbara McMillin Ezell
• Casey Devaughn Fleming, NP-C
• Focuscare, LLC
• Laken Nicole Fulcher, FNP

• Assisted Living Facility in Louisville, MS
• Providers in Louisville, 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 Jan 17, 2015; 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.