Gulf Gardens Residential and Community Living LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

GULF GARDENS RESIDENTIAL AND COMMUNITY LIVING LLC

Practice address

460 Briarwood Dr Ste 400
Jackson, MS 39206-3062

Phone

(601) 203-1016

Fax

(601) 709-4611

NPI assigned

May 25, 2018

Organization subpart

No

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

Authorized official

Name

Jacqueline C Edwards, MSN, FNPCNPI 1740688910

Title

Director of Nursing

Phone

(678) 237-7183

Specialties & licenses 2

Addresses

Other names 1

• GGRCL Doing business as

Locations

Practitioners 1

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

• Jacqueline Carolyn Edwards, N.P., RN

  • Family Nurse Practitioner
  • Jonesboro, GA
  • NPI 1740688910
  NPD Authorized official

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

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598918400000",
    "number": "1831680792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 BRIARWOOD DR STE 400",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063062",
            "telephone_number": "601-203-1016",
            "fax_number": "601-709-4611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 BRIARWOOD DR STE 400",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063062",
            "telephone_number": "601-203-1016",
            "fax_number": "601-709-4611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF GARDENS RESIDENTIAL AND COMMUNITY LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-25",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "678-237-7183",
        "authorized_official_credential": "MSN, FNPC"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GGRCL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andreina Guedez Mijares, MS, RD, LD
• Christine Guidry, PMHNP-BC
• Cameron S Guild, MD
• Ashlee Guillory, ATC
• Vinita Gulanikar, MD
• Gulf States Physical Medicine & Rehabilitation
• George Woodson Gully Jr., LPN
• Ashish Gummadi, MD
• Jessica Brooke Gunn, LPTA
• Andrew Gunter, MS, CGC

• All providers in Jackson, MS
• Developmentally Disabled Services Day Training Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; 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.