CHURCH STREET MANOR ASSISTED LIVING, INC. - NPI 1780287979 - Assisted Living Facility in Ecru, MS

Q: What is Church Street Manor Assisted Living, Inc.'s specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

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About Church Street Manor Assisted Living, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHURCH STREET MANOR ASSISTED LIVING, INC. (NPI 1780287979) is a healthcare organization registered as an assisted living facility in Ecru, Mississippi and active in the NPI registry since November 2020. The organization holds a CLIA Waiver certificate valid through November 30, 2026 and lists Kenneth A Long, President, as its authorized official.

NPPES Registry Identity

NPI1780287979

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameCHURCH STREET MANOR ASSISTED LIVING, INC.

Location Address36 ELM LNEcru, MS 38841-9794

Mailing AddressPo Box 4150Tupelo, MS 38803-4150 · (662) 322-4636 · Fax (662) 840-3311

Phone(662) 489-6462

Fax(662) 489-6491

Organization SubpartNo

Authorized OfficialKenneth A LongPresident · (662) 401-8930

Enumeration DateNovember 19, 2020

NPPES CertifiedNovember 19, 2020

✔ NPI 1780287979 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

36 ELM LN, Ecru, MS 38841

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2202882

Church Street Manor · Ecru, MS

Active · expires Nov 30, 2026

CLIA Number25D2202882

Laboratory TypeAssisted Living Facility

Certificate Effective DateDecember 1, 2024

Certificate Expiration DateNovember 30, 2026

Laboratory DirectorShelia D. Brady

Laboratory Phone(662) 489-6462

Laboratory LocationChurch Street Manor36 Elm Ln, Ecru, MS 38841

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Church Street Manor Assisted Living, Inc.'s NPI number?

The NPI number for Church Street Manor Assisted Living, Inc. is 1780287979. It was assigned to this organization in the NPPES registry on November 19, 2020.

Where is Church Street Manor Assisted Living, Inc. located?

Church Street Manor Assisted Living, Inc. is located at 36 Elm Ln, Ecru, MS 38841. The listed phone number is (662) 489-6462.

What is Church Street Manor Assisted Living, Inc.'s specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Church Street Manor Assisted Living, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2202882) is associated with this NPI, valid through November 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Church Street Manor Assisted Living, Inc. was last updated on November 19, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.