Journeypure Southaven, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

JOURNEYPURE SOUTHAVEN, LLC

Practice address

8829 Centre St
Southaven, MS 38671-2610

Phone

(662) 536-6542

NPI assigned

Nov 4, 2016

Last updated

Jun 30, 2020By 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

Kim Cooper

Title

Human Resources

Phone

(662) 536-6542

Specialties & licenses 1

Addresses

Tax ID family

Journeypure Southaven LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Journeypure Southaven, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Southaven, MS
  • NPI 1396288361
  NPD tax ID

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593475200000",
    "number": "1336681584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8829 CENTRE ST",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712610",
            "telephone_number": "662-536-6542",
            "fax_number": "662-314-9689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8829 CENTRE ST",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712610",
            "telephone_number": "662-536-6542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOURNEYPURE SOUTHAVEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "HUMAN RESOURCES",
        "authorized_official_telephone_number": "662-536-6542"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharunda Jones
• Taylor Jones
• Cheryl Jordan, MS CCC-SLP
• Journey to New Beginnings, PLLC
• Journeypure Mississippi Medical Group LLC
• Journeypure Southaven, LLC
• Kacey S. Joyner, ATC
• John George Kakales, DDS
• Tracy Elizabeth Kammerer
• Rebecca Kane, BCBA

• Substance Use Disorder Rehabilitation Clinic/Center in Southaven, MS
• Providers in Southaven, MS by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; 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.