IDEAL PROVIDER, LLC; NPI #1013141357

Contact Information

IDEAL PROVIDER, LLC

8869 CENTRE ST # 3
SOUTHAVEN, MS 38671-1725

Phone: 662-342-7023
Fax: 662-342-7089
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Respite Care	385H00000X
Adolescent and Children Mental Health	261QM0855X
Long Term Care Hospital	282E00000X	A0[7]	Hospital-Long-Term (PPS excluded)

Indicates primary specialty

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NPI Profile & details for IDEAL PROVIDER, LLC

NPI Number	`1013141357`
LBN Legal business name	IDEAL PROVIDER, LLC
Authorized official	NGOZI EDMUNDS - (PRESIDENT)
Entity	Organization
Organization subpart ¹	No
Enumeration date	05/13/2009
Last updated	05/13/2009 - About 17 years ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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