Emmanuel Ridge of Dekalb Inc

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

License

08752218 Issued in MS

Legal business name

EMMANUEL RIDGE OF DEKALB INC

Doing business as

Adult Daycare Health Services

Practice address

14632 Hwy 39N/16E
Dekalb, MS 39328

Phone

(601) 927-9839

NPI assigned

Apr 15, 2015

Last updated

Apr 15, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Beatrice Ezem, RN,CM,CLNC

Title

Ceo

Phone

(601) 927-9839

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• ADULT DAYCARE HEALTH SERVICES Doing business as

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

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429056000000",
    "number": "1992191084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1522",
            "city": "FLORENCE",
            "state": "MS",
            "postal_code": "390731522",
            "telephone_number": "601-927-9839",
            "fax_number": "769-251-0257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14632 HWY 39N/16E",
            "city": "DEKALB",
            "state": "MS",
            "postal_code": "39328",
            "telephone_number": "601-927-9839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMMANUEL RIDGE OF DEKALB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-15",
        "last_updated": "2015-04-15",
        "status": "A",
        "authorized_official_last_name": "EZEM",
        "authorized_official_first_name": "BEATRICE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-927-9839",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN,CM,CLNC"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "MS",
            "license": "R815521",
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "MS",
            "license": "08752218",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MS",
            "license": "03630719",
            "primary": false
        },
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "MS",
            "license": "08752218",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08752218",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADULT DAYCARE HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bio-Medical Applications of Mississippi, Inc. (Fresenius Medical Care Kemper County)
• Kiara Bourrage, RN
• William Martin Bracken, DO
• Patricia Dunlap, MD
• Latorie Dunn-King, CMHT
• Haley Ezelle
• Father of Waters Emergency Physicians LLC
• Brandon Nicholas Goza, D.M.D.
• Hannah Gray, FNP
• Greater Meridian Health Clinic, Inc. (Kemper Family Medical Center)

• Adult Day Care Clinic/Center in De Kalb, MS
• Providers in De Kalb, MS by specialty
• Adult Day Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2015; 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.