Sentry-Brandon, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

780 Issued in MS

Legal business name

SENTRY-BRANDON, INC.

Doing business as

Peachtree Village

Practice address

6100 Old Brandon Rd
Brandon, MS 39042-2543

Phone

(601) 933-1100

Fax

(601) 933-1113

NPI assigned

Jan 30, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Cameron D Goddard

Title

Ar Manager

Phone

(601) 824-9010

Specialties & licenses 1

Addresses

Other names 1

• Peachtree Village Doing business as

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

{
    "created_epoch": "1391040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391040000000",
    "number": "1548683360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1499",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390431499",
            "telephone_number": "601-824-9010",
            "fax_number": "601-824-9044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 OLD BRANDON RD",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390422543",
            "telephone_number": "601-933-1100",
            "fax_number": "601-933-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENTRY-BRANDON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-30",
        "last_updated": "2014-01-30",
        "status": "A",
        "authorized_official_last_name": "GODDARD",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "AR MANAGER",
        "authorized_official_telephone_number": "601-824-9010",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peachtree Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristen Selman, PT
• Elaine E Sendelweck, LMSW
• Chelsea Senitko, APRN
• Sentry Rehab, LLC
• Sentry Rehab, LLC
• Meghan Seymour, PA-C
• Alexis Monet Shannon, MSW
• Brenda Sharp
• Kholada Shaw
• Michael George Shaw, PMHNP-BC

• Assisted Living Facility in Brandon, MS
• Providers in Brandon, MS by specialty
• Assisted Living Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2014; 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.