Charleston Place

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

1017 Issued in MS

Legal business name

CHARLESTON PLACE

Practice address

804 S Adams St
Fulton, MS 38843-6049

Phone

(662) 862-2465

Fax

(662) 862-9525

NPI assigned

Jan 16, 2009

Last updated

Oct 27, 2014By the provider in NPPES

Organization subpart

Yes

Parent organization

DANIEL HEALTH CARE, INC.As reported in NPPES

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

Authorized official

Name

Jackie Jones

Title

Financial Cordinator

Phone

(662) 862-2165

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Tax ID family

Charleston Place2 organizations share this tax ID, including this one

Part of

Charleston Place

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Daniel Health Care, Inc.

  • Skilled Nursing Facility
  • Fulton, MS
  • NPI 1952307316
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Daniel Health Care, Inc.

  • Skilled Nursing Facility
  • Fulton, MS
  • NPI 1952307316
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amanda Jody Johnson-Kelly, DNP, FNP-BC

  • Family Nurse Practitioner
  • Fulton, MS
  • NPI 1457457814
  NPD (past)

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

{
    "created_epoch": "1232064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414368000000",
    "number": "1881831584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 127",
            "city": "FULTON",
            "state": "MS",
            "postal_code": "388430127",
            "telephone_number": "662-862-2465",
            "fax_number": "662-862-9592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 S ADAMS ST",
            "city": "FULTON",
            "state": "MS",
            "postal_code": "388436049",
            "telephone_number": "662-862-2465",
            "fax_number": "662-862-9525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON PLACE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DANIEL HEALTH CARE, INC.",
        "enumeration_date": "2009-01-16",
        "last_updated": "2014-10-27",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "FINANCIAL CORDINATOR",
        "authorized_official_telephone_number": "662-862-2165"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "1017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Farris Burns, FNP-C
• C's Violet's Love Transportation and Services, Inc
• Cagle Eye Center
• Laurie Wade Cagle, O.D.
• Center for Behavior Analytic Services, LLC
• Rachel Chism, SLP
• CLC of Fulton, LLC (Courtyards Community Living Center)
• Tammy Marie Collier, M.S., CCC-SLP
• Complete Home Care Inc.
• Convenient Care of Fulton Inc

• Assisted Living Facility in Fulton, MS
• Providers in Fulton, 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 Oct 27, 2014; 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.