NPIMap

Organization Active NPI

Preferred Care Developmental Centers of Ms I Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Brookhaven, MS
National Provider Identifier
1174505010
Registry record updated Jun 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
629 Issued in MS
Legal business name
PREFERRED CARE DEVELOPMENTAL CENTERS OF MS I INC
Doing business as
Lincoln Residential Center
Practice address
524 Brookman Dr
Brookhaven, MS 39601-2384
Phone
(601) 835-1884
Fax
(601) 833-0430
NPI assigned
Nov 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2011

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

Authorized official

Name
Mrs. Jamie Latture Collier
Title
Director of Reimbursement
Phone
(972) 931-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 629 MS Primary

Addresses

Primary practice location

524 Brookman Dr
Brookhaven, MS 39601-2384

Mailing address

5420 W Plano Pkwy
Plano, TX 75093-4823
Phone (972) 931-3800

Other identifiers 1

IdentifierTypeStateIssuer
00220055MedicaidMS

Other names 1

  • Lincoln Residential Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Canton Manor4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309219200000",
    "number": "1174505010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5420 W PLANO PKWY",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750934823",
            "telephone_number": "972-931-3800",
            "fax_number": "972-767-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 BROOKMAN DR",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012384",
            "telephone_number": "601-835-1884",
            "fax_number": "601-833-0430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREFERRED CARE DEVELOPMENTAL CENTERS OF MS I INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2011-06-28",
        "status": "A",
        "authorized_official_last_name": "COLLIER",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "LATTURE",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "972-931-3800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MS",
            "license": "629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00220055",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lincoln Residential Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookhaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; 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.