NPIMap

Organization Active NPI

Preferred Care Developmental Centers of Ms I, Inc.

Doing business as Delta Manor

  • Intellectual Disabilities Intermediate Care Facility
  • Clarksdale, MS
National Provider Identifier
1710969787
Registry record updated Aug 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
631 Issued in MS
Legal business name
PREFERRED CARE DEVELOPMENTAL CENTERS OF MS I, INC.
Doing business as
Delta Manor
Practice address
701 Highway 322
Clarksdale, MS 38614-4722
Phone
(662) 627-2212
Fax
(662) 627-1727
NPI assigned
Nov 16, 2005
Last updated
Aug 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2011

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

Authorized official

Name
Mrs. Jamie Latture Collier
Title
Director of Reimbursement
Phone
(972) 931-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 631 MS Primary

Addresses

Primary practice location

701 Highway 322
Clarksdale, MS 38614-4722

Mailing address

5420 W Plano Pkwy
Plano, TX 75093-4823
Phone (972) 931-3800

Other identifiers 1

IdentifierTypeStateIssuer
00220056MedicaidMS

Other names 1

  • Delta Manor Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Canton Manor4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

701 Highway 322
Clarksdale, MS 38614
Phone (662) 627-2212

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312416000000",
    "number": "1710969787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5420 W PLANO PKWY",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750934823",
            "telephone_number": "972-931-3800",
            "fax_number": "972-767-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 HIGHWAY 322",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386144722",
            "telephone_number": "662-627-2212",
            "fax_number": "662-627-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREFERRED CARE DEVELOPMENTAL CENTERS OF MS I, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2011-08-04",
        "status": "A",
        "authorized_official_last_name": "COLLIER",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "LATTURE",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "972-931-3800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MS",
            "license": "631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00220056",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksdale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; 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.