Fondren Cove Relay, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

FONDREN COVE RELAY, INC.

Doing business as

Fondren Cove Assited Living

Practice address

4520 N State St
Jackson, MS 39206-5307

Phone

(601) 981-3945

NPI assigned

Nov 28, 2012

Last updated

Nov 28, 2012By 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. Cammie E Kitchens

Title

Executive Director

Phone

(601) 981-3945

Specialties & licenses 1

Addresses

Other names 1

• Fondren Cove Assited Living Doing business as

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1811232135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 55861",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392965861",
            "telephone_number": "601-981-3945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392065307",
            "telephone_number": "601-981-3945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FONDREN COVE RELAY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-28",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "KITCHENS",
        "authorized_official_first_name": "CAMMIE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-981-3945",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fondren Cove Assited Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joel Ray Flynt, M.D.
• Bridget Foley, NNP
• Michael Folkes
• Jacob M Folse, MD
• Cydney Fondel, DO
• Fondren Health Clinic
• Fondren Medical Clinic
• Fondren Nightingales Physical Therapy LLC
• Fondren Nightingales Senior Day Retreat Co
• John E Fontaine IV, PH.D.

• Assisted Living Facility (Mental Illness) in Jackson, MS
• Providers in Jackson, 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 Nov 28, 2012; 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.