Organization
EMMANUEL RIDGE HOUSING INC
Active
Other names
ASSISTED/EXTENDED STAY FACILITY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BEATRICE A EZEM RN,CM,CLNC (CEO)
(601) 927-9839
Entity
Organization
Contact information
Practice address
803 W MAIN ST, LOUISVILLE, MS 39339-2539
(662) 705-5031
(662) 705-5034
Mailing address
750 BOLING ST, SUITE H, JACKSON, MS 39209-2652
(769) 233-7439
(769) 251-0257
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
MS
311ZA0620X
Adult Care Home Facility
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03630719
—
MS
05
—
07123515
—
MS
05
—
08762218
—
MS
Enumeration date
01/17/2015
Last updated
01/17/2015
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