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

Fax

(662) 314-9689

NPI assigned

Nov 23, 2016

Organization subpart

No

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

Authorized official

Name

Candace Thompson, MD

Title

Medical Director

Phone

(662) 536-6542

Specialties & licenses 1

Addresses

Other identifiers 1

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 1336681584
  NPD tax ID

Locations

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

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592265600000",
    "number": "1396288361",
    "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",
            "fax_number": "662-314-9689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOURNEYPURE SOUTHAVEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-23",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "662-536-6542",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 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
• Joshua Kaplan, CADC II (COUNSELOR)

• 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 16, 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.