NPIMap

Organization Active NPI

Mississippi State Hospital

Doing business as Jaquith Nursing Home - Washington Inn

  • Skilled Nursing Facility
  • Pearl, MS
National Provider Identifier
1467532903
Registry record updated Nov 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
939 Issued in MS
Legal business name
MISSISSIPPI STATE HOSPITAL
Doing business as
Jaquith Nursing Home - Washington Inn
Practice address
3550 Highway 468 W
Pearl, MS 39208-5529
Phone
(601) 351-8000
Fax
(601) 351-8301
NPI assigned
Oct 17, 2006
Last updated
Nov 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2010

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

Authorized official

Name
Mr. James G Chastain
Title
Director
Phone
(601) 351-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 939 MS Primary

Addresses

Primary practice location

3550 Highway 468 W
Pearl, MS 39208-5529

Mailing address

PO Box 157a
Whitfield, MS 39193-0157
Phone (601) 351-8000

Other identifiers 1

IdentifierTypeStateIssuer
00230123MedicaidMS

Other names 1

  • Jaquith Nursing Home - Washington Inn Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ms State Hospital Crisis Intervention Center - Clevenlan21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290988800000",
    "number": "1467532903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 157A",
            "city": "WHITFIELD",
            "state": "MS",
            "postal_code": "391930157",
            "telephone_number": "601-351-8000",
            "fax_number": "601-351-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 HIGHWAY 468 W",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392085529",
            "telephone_number": "601-351-8000",
            "fax_number": "601-351-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI STATE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2010-11-29",
        "status": "A",
        "authorized_official_last_name": "CHASTAIN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-351-8000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "939",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00230123",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jaquith Nursing Home - Washington Inn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pearl, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 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.