Indywood Estate, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

960 Issued in MS

Legal business name

INDYWOOD ESTATE, LLC

Practice address

218 Ronaldman Rd
Cleveland, MS 38732-8755

Phone

(662) 843-7885

Fax

(662) 843-7985

NPI assigned

Sep 7, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Sharon Harvey

Title

Assistant Manager

Phone

(662) 455-3878

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346976000000",
    "number": "1942559745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 ERIE ST",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389302103",
            "telephone_number": "662-455-3878",
            "fax_number": "662-455-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 RONALDMAN RD",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387328755",
            "telephone_number": "662-843-7885",
            "fax_number": "662-843-7985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDYWOOD ESTATE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-07",
        "last_updated": "2012-09-07",
        "status": "A",
        "authorized_official_last_name": "HARVEY",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "ASSISTANT MANAGER",
        "authorized_official_telephone_number": "662-455-3878",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00037512",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Cleveland, MS
• Providers in Cleveland, 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 Sep 7, 2012; 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.