Provider Demographics
NPI:1558499806
Name:PLEASANT LIVING CARE COORDINATION
Entity type:Organization
Organization Name:PLEASANT LIVING CARE COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:601-966-1820
Mailing Address - Street 1:5185 SEDGWICK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4808
Mailing Address - Country:US
Mailing Address - Phone:601-966-1820
Mailing Address - Fax:601-206-1407
Practice Address - Street 1:5185 SEDGWICK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-4808
Practice Address - Country:US
Practice Address - Phone:601-966-1820
Practice Address - Fax:601-206-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07828705347C00000X
MS07556060376J00000X
MS01682361385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01682361Medicaid
MS07556060Medicaid
MS07828705Medicaid