Personal Care Home of Wiggins

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

1038 Issued in MS

Legal business name

PERSONAL CARE HOME OF WIGGINS

Practice address

918 Parkway Dr
Wiggins, MS 39577-8750

Phone

(601) 928-4663

Fax

(601) 928-4668

NPI assigned

Aug 30, 2010

Last updated

Aug 30, 2010By 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

Angela C Harris

Title

Owner/Administrator

Phone

(601) 325-4577

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283126400000",
    "number": "1386950145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 PARKWAY DR",
            "city": "WIGGINS",
            "state": "MS",
            "postal_code": "395778750",
            "telephone_number": "601-928-4663",
            "fax_number": "601-928-4668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 PARKWAY DR",
            "city": "WIGGINS",
            "state": "MS",
            "postal_code": "395778750",
            "telephone_number": "601-928-4663",
            "fax_number": "601-928-4668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONAL CARE HOME OF WIGGINS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-30",
        "last_updated": "2010-08-30",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "601-325-4577"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "1038",
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "MS",
            "license": "1038",
            "primary": true
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "MS",
            "license": "1038",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dillon Ott, O.D.
• Erica R Palmer
• Leslie Parker
• Rebekah Parker, D.C.
• Robert K Partrige, MD
• Hannah Jean Peterman, DMD
• Vera Phenice
• Jeffrey N Potter, MD
• Quest Rehab, Inc.
• Aesha Rahman, M.D.

• Assisted Living Facility (Mental Illness) in Wiggins, MS
• Providers in Wiggins, MS by specialty
• Assisted Living Facility (Mental Illness) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; 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.