Cottage Grove Nursing Home, LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

326 Issued in MS

Legal business name

COTTAGE GROVE NURSING HOME, LP

Practice address

1116 Forest Ave
Jackson, MS 39206-3216

Phone

(601) 366-6461

Fax

(601) 362-4041

NPI assigned

Jan 9, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Juadine B Cleveland

Title

Administrator

Phone

(601) 366-6461

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364256000000",
    "number": "1326197211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 FOREST AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063216",
            "telephone_number": "601-366-6461",
            "fax_number": "601-362-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 FOREST AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063216",
            "telephone_number": "601-366-6461",
            "fax_number": "601-362-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COTTAGE GROVE NURSING HOME, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2013-03-26",
        "status": "A",
        "authorized_official_last_name": "CLEVELAND",
        "authorized_official_first_name": "JUADINE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-366-6461",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00023040",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Margaret McLendon Cosnahan, MD
• Kim K Costello, M.S., CCC-SLP
• Austin Cottam
• Ashuena Stenae Cotten
• Ellen Renee Cotten, LCSW
• Vernon Reid Cotten Jr., MD
• Mairin Claire Madison Cotter

• Skilled Nursing Facility in Jackson, MS
• Providers in Jackson, MS by specialty
• Skilled Nursing Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.