Educare Senior Day Center (Vicksburg Branch)

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

EDUCARE SENIOR DAY CENTER (VICKSBURG BRANCH)

Practice address

3202 Wisconsin Ave
Vicksburg, MS 39180-5351

Phone

(601) 624-0311

Fax

(866) 683-2362

NPI assigned

Oct 6, 2015

Organization subpart

Yes

Parent organization

EDUCARE SENIOR DAY CENTERAs reported in NPPES

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

Authorized official

Name

Angela Courtney

Title

Administrator

Phone

(601) 624-0311

Specialties & licenses 1

Addresses

Tax ID family

Educare Senior Day Center2 organizations share this tax ID, including this one

Part of

Educare Senior Day Center

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Educare Senior Day Center

  • Adult Day Care Clinic/Center
  • Byram, MS
  • NPI 1235546698
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Educare Senior Day Center

  • Adult Day Care Clinic/Center
  • Byram, MS
  • NPI 1235546698
  NPPES parent name

Practitioners 1

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

• Angela Courtneey

  • Case Manager/Care Coordinator
  • Byram, MS
  • NPI 1033523857
  NPD (past)

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

{
    "created_epoch": "1444089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1679943310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 TORREY PINES DR",
            "city": "BYRAM",
            "state": "MS",
            "postal_code": "392725778",
            "telephone_number": "601-624-0311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3202 WISCONSIN AVE",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805351",
            "telephone_number": "601-624-0311",
            "fax_number": "866-683-2362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDUCARE SENIOR DAY CENTER (VICKSBURG BRANCH)",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDUCARE SENIOR DAY CENTER",
        "enumeration_date": "2015-10-06",
        "last_updated": "2015-10-06",
        "status": "A",
        "authorized_official_last_name": "COURTNEY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-624-0311"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Danielle Dunaway, OTD
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• Stanley R Easterling, MD
• Daniel P Edney, MD
• Edward Brown Specialty Partners of Mississippi, PLLC
• Natalie Edwards
• Terriaunce Edwards
• Kimberly Lynn Eldridge, MSN, FNP-BC, CWCN
• Elite Performance and Rehab, LLC

• Adult Care Home Facility in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Adult Care Home Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; 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.