NPIMap

Organization Active NPI

Grenada Lake Medical Center

Doing business as Parkwood Pavilion at Grenada

  • Psychiatric Hospital Unit
  • Grenada, MS
National Provider Identifier
1215165642
Registry record updated Jul 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
11-245 Issued in MS
Legal business name
GRENADA LAKE MEDICAL CENTER
Doing business as
Parkwood Pavilion at Grenada
Practice address
960 Avent Dr
Grenada, MS 38901-5230
Phone
(662) 227-7000
Fax
(662) 227-7534
NPI assigned
Jun 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2009

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

Authorized official

Name
Mr. Charles L Denton
Title
Ceo
Phone
(662) 227-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 11-245 MS Primary

Addresses

Primary practice location

960 Avent Dr
Grenada, MS 38901-5230

Mailing address

960 Avent Dr
Grenada, MS 38901
Phone (662) 227-7000

Other names 1

  • Parkwood Pavilion at Grenada Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247011200000",
    "number": "1215165642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 AVENT DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "38901",
            "telephone_number": "662-227-7000",
            "fax_number": "662-227-7534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 AVENT DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015230",
            "telephone_number": "662-227-7000",
            "fax_number": "662-227-7534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENADA LAKE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-24",
        "last_updated": "2009-07-08",
        "status": "A",
        "authorized_official_last_name": "DENTON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-227-7000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "MS",
            "license": "11-245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkwood Pavilion at Grenada",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grenada, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.