Church Street Manor Assisted Living, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CHURCH STREET MANOR ASSISTED LIVING, INC.

Practice address

36 Elm LN
Ecru, MS 38841-9794

Phone

(662) 489-6462

Fax

(662) 489-6491

NPI assigned

Nov 19, 2020

Last updated

Nov 19, 2020By 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

Mr. Kenneth A Long

Title

President

Phone

(662) 401-8930

Specialties & licenses 1

Addresses

Electronic endpoints 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1780287979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4150",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388034150",
            "telephone_number": "662-322-4636",
            "fax_number": "662-840-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 ELM LN",
            "city": "ECRU",
            "state": "MS",
            "postal_code": "388419794",
            "telephone_number": "662-489-6462",
            "fax_number": "662-489-6491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCH STREET MANOR ASSISTED LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-401-8930",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Ecru",
            "affiliation": "N",
            "endpointDescription": "Local Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "36 Elm Ln",
            "city": "Ecru",
            "state": "MS",
            "country_code": "US",
            "postal_code": "388419794",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Michael L Atkeison
• Allison Miller Bailey, CFNP
• Jennifer Chism Bolen, FNP-C
• Felicia Daniel, FNP-BC
• Sabrina Davidson, FNP
• Tracey Michelle Foreman, FNP
• Friendship Medical Clinic, LLC
• Friendship, LLC

• Assisted Living Facility in Ecru, MS
• Providers in Ecru, MS by specialty
• Assisted Living Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.