Mind Repose LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

MIND REPOSE LLC

Doing business as

The Historic Blue Rose Recovery Mansion

Practice address

120 W Scenic Dr
Pass Christian, MS 39571-4420

Phone

(480) 300-2655

NPI assigned

Jan 25, 2022

Last updated

Jan 25, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Daniel Case Sr., PHD

Title

Ceo

Phone

(480) 300-2655

Specialties & licenses 15

Addresses

Other identifiers 1

Other names 3

• The Historic Blue Rose Recovery Mansion Doing business as
• Mind Repose LLC Former legal business name
• Blue Rose Detox Mansion Other name

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1609528272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 3RD AVE STE 1143",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100227649",
            "telephone_number": "480-300-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W SCENIC DR",
            "city": "PASS CHRISTIAN",
            "state": "MS",
            "postal_code": "395714420",
            "telephone_number": "480-300-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND REPOSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-25",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "CASE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-300-2655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "",
            "desc": "Psychologist, Psychoanalysis",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "102L00000X",
            "taxonomy_group": "",
            "desc": "Psychoanalyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MISSISSIPPI",
            "identifier": "1134710817",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "SharePoint",
            "affiliation": "N",
            "endpointDescription": "Closed System",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "120 W Scenic Dr",
            "city": "Pass Christian",
            "state": "MS",
            "country_code": "US",
            "postal_code": "395714420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Historic Blue Rose Recovery Mansion",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mind Repose LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Blue Rose Detox Mansion",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jessica Marie McMichael, DDS
• Philip Albert McShane, PHARMD
• Memorial Hospital at Gulfport (Physicians Clinic at MHG)
• Rachel Louise Meredith
• Christine Miller, LPC
• Mind Works Therapy PLLC (Mind Works Psychologists)
• Mission Nutrition, L.L.C.
• Mississippi Dental Arts
• Mississippi Superior Senior Services (Right at Home)
• Kristi Mong, PH.D.

• Substance Abuse Rehabilitation Facility in Pass Christian, MS
• Providers in Pass Christian, MS by specialty
• Substance Abuse Rehabilitation Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.