Provider Demographics
NPI:1184608804
Name:CARE MANAGEMENT GROUP INC
Entity type:Organization
Organization Name:CARE MANAGEMENT GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-304-0980
Mailing Address - Street 1:314 ENOCHS ST
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-2716
Mailing Address - Country:US
Mailing Address - Phone:601-876-2173
Mailing Address - Fax:601-876-4904
Practice Address - Street 1:314 ENOCHS ST
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2716
Practice Address - Country:US
Practice Address - Phone:601-876-2173
Practice Address - Fax:601-876-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS179310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230053Medicaid
MS00230053Medicaid