NPIMap

Organization Active NPI

Aaron E Henry Community Health

  • Federally Qualified Health Center (FQHC)
  • Tunica, MS
National Provider Identifier
1912905993
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AARON E HENRY COMMUNITY HEALTH
Practice address
744 School St
Tunica, MS 38676-9369
Phone
(662) 363-3971
Fax
(662) 363-3789
NPI assigned
Jul 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Authorized official

Name
Ms. Aurelia Taylor
Title
Cheif Executive Office
Phone
(662) 624-4292

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

744 School St
Tunica, MS 38676-9369

Mailing address

510 Highway 322
P O Box 1216
Clarksdale, MS 38614-4717
Phone (662) 624-4292

Other identifiers 1

IdentifierTypeStateIssuer
01173078MedicaidMS

Other names 1

  • Tunica Rosa Fort School Based Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030304000015 MS Part A Provider - Federally Qualified Health Center (FQHC) 1153230560 Practice locations: Tunica, MS

Federally qualified health center certification: CCN 251918

Legal name
AARON E HENRY COMMUNITY HEALTH
Doing business as
TUNICA ROSA FORT SCHOOL BASED CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 19, 2003
Last certification
May 19, 2003
Ownership / control type
Non-profit – other
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1979 in MS
Enrollment address
1100 Rosa Fort Drive
Tunica, MS 38676-1823

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Aaron E Henry Community Health18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

1100 Rosa Fort St
Tunica, MS 38676
Phone (662) 363-3971

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Raymond Cole Individual Corporate Director Apr 9, 2003
Orlando Paden Individual Corporate DirectorBoard Member Feb 20, 2012 100%
Georgia Tolliver Individual Corporate Director Apr 9, 2003
Lydia Rios Individual Corporate DirectorBoad Member May 17, 2010 100%
Larry Haynes Individual Corporate Director Apr 9, 2003
Aurelia Jones-Taylor Individual 5% Or Greater Direct Ownership InterestChief Executive Officer Jun 5, 1989 100%
Corporate Director Apr 9, 2003
W-2 Managing Employee Jun 5, 1989
Josephine Rhymes Individual Corporate Director Apr 9, 2003
Robert Jackson Individual Corporate Director Apr 9, 2003

NPI Registry JSON

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1912905993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 HIGHWAY 322",
            "address_2": "P O BOX 1216",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386144717",
            "telephone_number": "662-624-4292",
            "fax_number": "662-624-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 SCHOOL ST",
            "city": "TUNICA",
            "state": "MS",
            "postal_code": "386769369",
            "telephone_number": "662-363-3971",
            "fax_number": "662-363-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AARON E HENRY COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "AURELIA",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICE",
        "authorized_official_telephone_number": "662-624-4292",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01173078",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tunica Rosa Fort School Based Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tunica Rosa Fort School Based Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tunica, MS

Sources for this page

Verify at the official NPI Registry.