NPIMap

Organization Active NPI

2ND Generation Healthcare, LLC

  • Skilled Nursing Facility
  • Columbia, MS
National Provider Identifier
1356651772
Registry record updated Jun 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
461 Issued in MS
Legal business name
2ND GENERATION HEALTHCARE, LLC
Practice address
11 Pecan Drive
Columbia, MS 39429
Phone
(601) 736-4747
NPI assigned
Oct 19, 2010
Last updated
Jun 1, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2018

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

Authorized official

Name
Michael Bradshaw
Title
Administrator
Phone
(601) 736-4747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 461 MS Primary

Addresses

Primary practice location

11 Pecan Drive
Columbia, MS 39429

Mailing address

11 Pecan Drive
Columbia, MS 39429

Other identifiers 2

IdentifierTypeStateIssuer
08039271MedicaidMS
255316OtherMSMEDICARE PROVIDER NUMBER

Other names 1

  • The Grove Outpatient Therapy Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
2ND Generation Healthcare 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.

Locations

11 Pecan Dr
Columbia, MS 39429
Phone (601) 731-5717

NPI Registry JSON

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

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527811200000",
    "number": "1356651772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 PECAN DRIVE",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "39429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 PECAN DRIVE",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "39429",
            "telephone_number": "601-736-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "2ND GENERATION HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-19",
        "last_updated": "2018-06-01",
        "status": "A",
        "authorized_official_last_name": "BRADSHAW",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-736-4747"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08039271",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "255316",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Grove Outpatient Therapy Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "The Grove Outpatient Therapy Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Columbia, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; 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.