Nissi LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

NISSI LLC

Doing business as

Magnolia Manor

Practice address

410 E First St
Forest, MS 39074-4204

Phone

(601) 469-4389

Fax

(601) 469-4377

NPI assigned

Feb 4, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Aaron Hines, LPN

Title

Nurse Manager

Phone

(601) 469-4389

Specialties & licenses 1

Addresses

Other names 1

• Magnolia Manor Doing business as

Locations

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

{
    "created_epoch": "1549238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549238400000",
    "number": "1841755865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 E FIRST ST",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390744204",
            "telephone_number": "601-469-4389",
            "fax_number": "601-469-4377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E FIRST ST",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390744204",
            "telephone_number": "601-469-4389",
            "fax_number": "601-469-4377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NISSI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-04",
        "last_updated": "2019-02-04",
        "status": "A",
        "authorized_official_last_name": "HINES",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "NURSE MANAGER",
        "authorized_official_telephone_number": "601-469-4389",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Mote, OT
• Mr Discount Drugs of Forest, Inc
• Deepthi Mundra, DDS
• Sara Bailey Murray, CFNP
• Nathan Lance Newman, CRNA
• Paula Stacy Norman, SLT
• Lauren Oswalt
• Megan Otto
• Tamatha Nicole Owen
• Charlotte C. Pace

• Assisted Living Facility (Mental Illness) in Forest, MS
• Providers in Forest, 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 Feb 4, 2019; 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.