Fondren Nightingales Senior Day Retreat Co

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

FONDREN NIGHTINGALES SENIOR DAY RETREAT CO

Practice address

3321 N West St
Jackson, MS 39216-3039

Phone

(601) 398-4485

Fax

(601) 398-1492

NPI assigned

Aug 29, 2018

Organization subpart

No

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

Authorized official

Name

Gregg Levy, LPNNPI 1053622134

Title

Ceo

Phone

(601) 398-4485

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregg B Levy, LPN

  • Homemaker
  • Jackson, MS
  • NPI 1053622134
  NPD Authorized official

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

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1629550363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3321 N WEST ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392163039",
            "telephone_number": "601-398-4485",
            "fax_number": "601-398-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3321 N WEST ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392163039",
            "telephone_number": "601-398-4485",
            "fax_number": "601-398-1492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FONDREN NIGHTINGALES SENIOR DAY RETREAT CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-29",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A",
        "authorized_official_last_name": "LEVY",
        "authorized_official_first_name": "GREGG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-398-4485",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053622134",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cydney Fondel, DO
• Fondren Cove Relay, Inc.
• Fondren Health Clinic
• Fondren Medical Clinic
• Fondren Nightingales Physical Therapy LLC
• John E Fontaine IV, PH.D.
• Molly Barron Fontenot
• Sarah Fontenot, PHARM.D.
• Kimberly C Fonville
• Andrew Forbes, RN, MED

• Adult Day Care Clinic/Center in Jackson, MS
• Providers in Jackson, MS by specialty
• Adult Day Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.