Provider Demographics
NPI:1154418481
Name:JEANS NON MEDICAL CARE RESPITE
Entity type:Organization
Organization Name:JEANS NON MEDICAL CARE RESPITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:OZIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:RESPITE PROVIDER
Authorized Official - Phone:662-382-8883
Mailing Address - Street 1:430 WILLIAMS AVE
Mailing Address - Street 2:P. O. BOX 72
Mailing Address - City:SLEDGE
Mailing Address - State:MS
Mailing Address - Zip Code:38670
Mailing Address - Country:US
Mailing Address - Phone:662-382-8883
Mailing Address - Fax:662-382-7776
Practice Address - Street 1:612 BROAD STREET
Practice Address - Street 2:612
Practice Address - City:SLEDGE
Practice Address - State:MS
Practice Address - Zip Code:38270
Practice Address - Country:US
Practice Address - Phone:662-382-8883
Practice Address - Fax:662-382-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07354332Medicaid