Emmanuel Ridge of Louisville Ms Inc

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

License

08752218 Issued in MS

Legal business name

EMMANUEL RIDGE OF LOUISVILLE MS INC

Doing business as

ADULT DAY HEALTH SERVICES

Practice address

803 W Main St
Louisville, MS 39339-2539

Phone

(662) 705-5031

Fax

(662) 705-5034

NPI assigned

Jan 16, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Beatrice A Ezem, RN,CM,CLNC

Title

Ceo

Phone

(601) 927-9839

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• ADULT DAY HEALTH SERVICES Doing business as

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

{
    "created_epoch": "1421366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421366400000",
    "number": "1497144265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 BOLING ST",
            "address_2": "SUITE H",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392092652",
            "telephone_number": "769-233-7437",
            "fax_number": "769-251-0257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 W MAIN ST",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393392539",
            "telephone_number": "662-705-5031",
            "fax_number": "662-705-5034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMMANUEL RIDGE OF LOUISVILLE MS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-16",
        "last_updated": "2015-01-16",
        "status": "A",
        "authorized_official_last_name": "EZEM",
        "authorized_official_first_name": "BEATRICE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-927-9839",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN,CM,CLNC"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Administrator",
            "state": "MS",
            "license": "R815521",
            "primary": false
        },
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "MS",
            "license": "08752218",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MS",
            "license": "03630719",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08752218",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADULT DAY HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patri Ellis, RPH
• Angela K Elmshaeuser, DPT
• Emergency Room MD LLC
• Emergency Room MD LLC
• Emmanuel Ridge Housing Inc
• Barbara McMillin Ezell
• Casey Devaughn Fleming, NP-C
• Focuscare, LLC
• Laken Nicole Fulcher, FNP
• James D Gentry, MD

• PACE Provider Organization in Louisville, MS
• Providers in Louisville, MS by specialty
• PACE Provider Organization in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; 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.