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Organization Active NPI

Heritage Manor PCH, Inc.

  • Assisted Living Facility
  • Silver Creek, MS
National Provider Identifier
1922271360
Registry record updated Apr 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
875 Issued in MS
Legal business name
HERITAGE MANOR PCH, INC.
Practice address
2051 Ferguson Mill Rd
Silver Creek, MS 39663-4435
Phone
(601) 886-7251
Fax
(601) 886-9990
NPI assigned
Apr 7, 2008
Last updated
Apr 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2008

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

Authorized official

Name
Mrs. Carrol Ann Hudspeth
Title
President
Phone
(601) 757-0059

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 875 MS Primary

Addresses

Primary practice location

2051 Ferguson Mill Rd
Silver Creek, MS 39663-4435

Mailing address

PO Box 1337
Monticello, MS 39654-1337
Phone (601) 886-7251

Other identifiers 1

IdentifierTypeStateIssuer
06376862MedicaidMS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1922271360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1337",
            "city": "MONTICELLO",
            "state": "MS",
            "postal_code": "396541337",
            "telephone_number": "601-886-7251",
            "fax_number": "601-886-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2051 FERGUSON MILL RD",
            "city": "SILVER CREEK",
            "state": "MS",
            "postal_code": "396634435",
            "telephone_number": "601-886-7251",
            "fax_number": "601-886-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR PCH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-07",
        "last_updated": "2008-04-07",
        "status": "A",
        "authorized_official_last_name": "HUDSPETH",
        "authorized_official_first_name": "CARROL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-757-0059",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06376862",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Silver Creek, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; 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.