Jerusalem Outreach Center, Inc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

JERUSALEM OUTREACH CENTER, INC

Practice address

710 Marshall St
Charleston, MS 38921-9506

Phone

(662) 625-6788

Fax

(662) 625-6787

NPI assigned

Nov 1, 2016

Organization subpart

No

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

Authorized official

Name

Bessie L Brooks

Title

Ceo/Director

Phone

(662) 625-6788

Specialties & licenses 2

Addresses

Other names 1

• Jerusalem Life Adjustment Center Doing business as

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

{
    "created_epoch": "1477958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1790237170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 MARSHALL ST",
            "address_2": "P.O. BOX 405",
            "city": "CHARLESTON",
            "state": "MS",
            "postal_code": "389219506",
            "telephone_number": "662-625-6788",
            "fax_number": "662-625-6787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 MARSHALL ST",
            "city": "CHARLESTON",
            "state": "MS",
            "postal_code": "389219506",
            "telephone_number": "662-625-6788",
            "fax_number": "662-625-6787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERUSALEM OUTREACH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-01",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "BESSIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO/DIRECTOR",
        "authorized_official_telephone_number": "662-625-6788"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385HR2065X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Physical Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jerusalem Life Adjustment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelsey Marter Faulkner
• Freds Pharmacy of Quitman
• Raedena Lancaster Hill, FNP-C
• Cuitna M Hoffman
• Thelma Thompson Hubbard, M.S.
• Louis Andrew Jones Jr., D.D.S.
• Michael M. Kempton, M.D.
• Joseph Andrew Kordsmeier, DO
• Jessica Elizabeth McGee, FNP-C
• Angela Miller, LCSW

• All providers in Charleston, MS
• Adult Care Home Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; 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.