Mind Repose LLC
Organization Active NPI Substance Abuse Rehabilitation Facility · Pass Christian, MS
NPI 1609528272 · NPPES record last updated Jan 25, 2022
Key facts
- NPI
- 1609528272
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Legal business name
- MIND REPOSE LLC
- Practice address
- 120 W Scenic Dr
Pass Christian, MS 39571-4420 - Phone
- (480) 300-2655
- NPI assigned
- Jan 25, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Daniel Case Sr., PHD
- Title
- Ceo
- Phone
- (480) 300-2655
National Provider Directory
Locations
120 W Scenic Dr
Pass Christian, MS 39571
Phone (480) 300-2655
800 3rd Ave
Ste 1143
New York, NY 10022
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | |||
| Psychoanalyst |
102L00000X | |||
| Addiction (Substance Use Disorder) Psychologist |
103TA0400X | |||
| Cognitive & Behavioral Psychologist |
103TB0200X | |||
| Clinical Psychologist |
103TC0700X | |||
| Counseling Psychologist |
103TC1900X | |||
| Prescribing (Medical) Psychologist |
103TP0016X | |||
| Psychoanalysis Psychologist |
103TP0814X | |||
| Group Psychotherapy Psychologist |
103TP2701X | |||
| Rehabilitation Psychologist |
103TR0400X | |||
| Addiction (Substance Use Disorder) Registered Nurse |
163WA0400X | |||
| Addiction Medicine (Family Medicine) Physician |
207QA0401X | |||
| Addiction Medicine (Psychiatry & Neurology) Physician |
2084A0401X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
120 W Scenic Dr
Pass Christian, MS 39571-4420
Mailing address
800 3Rd Ave Ste 1143
New York, NY 10022-7649
Phone (480) 300-2655
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134710817 | Other | MS | STATE OF MISSISSIPPI |
Other names
- The Historic Blue Rose Recovery Mansion
- Mind Repose LLC
- Blue Rose Detox Mansion
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | SharePoint | Direct |
Other providers in Pass Christian, MS
- Jessica Marie McMichael
- Philip Albert McShane
- Memorial Hospital at Gulfport
- Rachel Louise Meredith
- Christine Miller
- Mind Works Therapy PLLC
- Mission Nutrition, L.L.C.
- Mississippi Dental Arts
- Mississippi Superior Senior Services
- Kristi Mong
All providers in Pass Christian, MS · Substance Abuse Rehabilitation Facility in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.