Ideal Community Care,LLC

Primary specialty

Respite CareTaxonomy code 385H00000X

Legal business name

IDEAL COMMUNITY CARE,LLC

Practice address

8869 Centre STR #3
Southaven, MS 38671

Phone

(662) 342-7023

Fax

(662) 342-7089

NPI assigned

Sep 6, 2013

Last updated

Sep 6, 2013By 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. Ngozi Edmunds

Title

Administrator

Phone

(662) 342-7023

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1378425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378425600000",
    "number": "1295160463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8869 CENTRE ST STE 3",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711725",
            "telephone_number": "662-342-7023",
            "fax_number": "662-342-7089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8869 CENTRE STR #3",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "38671",
            "telephone_number": "662-342-7023",
            "fax_number": "662-342-7089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL COMMUNITY CARE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-06",
        "last_updated": "2013-09-06",
        "status": "A",
        "authorized_official_last_name": "EDMUNDS",
        "authorized_official_first_name": "NGOZI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-342-7023",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Lynn Hurt, M.S., CF-SLP
• Mary Hutcheson, P-LPC
• Quentin Hutchinson, M.S., BCBA, LBA
• Victoria Hutchinson, BCBA
• Iac Diagnostic Screening Lab
• Ideal Provider, LLC
• In Loving Care Home Care LLC
• Ashoka Ravi Varma Indukuri Venkata Madhava, MD
• Christopher Ingram
• Inspire Health and Wellness LLC

• Respite Care in Southaven, MS
• Providers in Southaven, MS by specialty
• Respite Care in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2013; 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.