Sunset Residential Center LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

SUNSET RESIDENTIAL CENTER LLC

Practice address

20114B Highway 18
Hermanville, MS 39086-9747

Phone

(601) 535-2059

Fax

(601) 535-2059

NPI assigned

Jun 25, 2019

Last updated

Jun 25, 2019By 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

Mrs. Gloria Jean Shoulders, PRESIDENT

Title

Owner

Phone

(601) 831-2371

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561420800000",
    "number": "1679134183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20114B HIGHWAY 18",
            "city": "HERMANVILLE",
            "state": "MS",
            "postal_code": "390869747",
            "telephone_number": "601-535-2059",
            "fax_number": "601-535-2059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20114B HIGHWAY 18",
            "city": "HERMANVILLE",
            "state": "MS",
            "postal_code": "390869747",
            "telephone_number": "601-535-2059",
            "fax_number": "601-535-2059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSET RESIDENTIAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-25",
        "last_updated": "2019-06-25",
        "status": "A",
        "authorized_official_last_name": "SHOULDERS",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-831-2371",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PRESIDENT"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Hermanville, MS
• Providers in Hermanville, MS by specialty
• Assisted Living Facility (Mental Illness) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; 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.