NPIMap

Organization Active NPI

Specialized Treatment Facility

  • Psychiatric Residential Treatment Facility
  • Gulfport, MS
National Provider Identifier
1467637488
Registry record updated Dec 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
981 Issued in MS
Legal business name
SPECIALIZED TREATMENT FACILITY
Practice address
14426 James Bond Rd
Gulfport, MS 39503-8311
Phone
(228) 328-6000
Fax
(228) 328-6035
NPI assigned
Jan 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2019

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

Authorized official

Name
Mrs. Shannon Y Bush, MPA
Title
Program Director
Phone
(228) 328-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X 981 MS Primary

Addresses

Primary practice location

14426 James Bond Rd
Gulfport, MS 39503-8311

Mailing address

14426 James Bond Rd
Gulfport, MS 39503-8311
Phone (228) 328-6000

Other identifiers 2

IdentifierTypeStateIssuer
04333899MedicaidMS
1013922954OtherMSNPI

National Provider Directory

National Provider Directory
Tax ID family
Specialized Treatment Facility2 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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575504000000",
    "number": "1467637488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14426 JAMES BOND RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395038311",
            "telephone_number": "228-328-6000",
            "fax_number": "228-328-6035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14426 JAMES BOND RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395038311",
            "telephone_number": "228-328-6000",
            "fax_number": "228-328-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALIZED TREATMENT FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2019-12-05",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "228-328-6000",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "MS",
            "license": "981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04333899",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1013922954",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2019; 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.