Northside Haven Association, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

992 Issued in MS

Legal business name

NORTHSIDE HAVEN ASSOCIATION, INC.

Doing business as

Miss Bernice's House

Practice address

50 Patton Place Rd
Lexington, MS 39095-5851

Phone

(662) 834-3344

Fax

(662) 834-3314

NPI assigned

Mar 26, 2007

Last updated

Dec 11, 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. Zelpha Montgomery Whatley

Title

Executive Director

Phone

(662) 834-3344

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Bernice's House Doing business as

Locations

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1063530467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 PATTON PLACE RD",
            "city": "LEXINGTON",
            "state": "MS",
            "postal_code": "390955851",
            "telephone_number": "662-834-3344",
            "fax_number": "662-834-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 PATTON PLACE RD",
            "city": "LEXINGTON",
            "state": "MS",
            "postal_code": "390955851",
            "telephone_number": "662-834-3344",
            "fax_number": "662-834-3314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE HAVEN ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "WHATLEY",
        "authorized_official_first_name": "ZELPHA",
        "authorized_official_middle_name": "MONTGOMERY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "662-834-3344",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09350005",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Miss Bernice's House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Peoples Drug Store Lexington Inc
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• Assisted Living Facility in Lexington, MS
• Providers in Lexington, 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 11, 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.