Saint Joshuas Therapeutic Group Home Inc

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

06071213 Issued in MS

Legal business name

SAINT JOSHUAS THERAPEUTIC GROUP HOME INC

Practice address

3409 N State St
Jackson, MS 39216-3136

Phone

(769) 257-5466

Fax

(866) 224-2940

NPI assigned

Dec 28, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Joshua T Smith

Title

President

Phone

(601) 316-4822

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293494400000",
    "number": "1568766905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4078 PINE HILL DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392065738",
            "telephone_number": "769-257-5466",
            "fax_number": "866-224-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392163136",
            "telephone_number": "769-257-5466",
            "fax_number": "866-224-2940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT JOSHUAS THERAPEUTIC GROUP HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-28",
        "last_updated": "2010-12-28",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-316-4822",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MS",
            "license": "06071213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Jackson, MS
• Providers in Jackson, MS by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.