1598749210 NPI number — HINDS COUNTY NURSING &REHABILITATION CENTER LLC

Table of content: (NPI 1598749210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598749210 NPI number — HINDS COUNTY NURSING &REHABILITATION CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HINDS COUNTY NURSING &REHABILITATION CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598749210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3454 ALBERMARLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-362-5394
Provider Business Mailing Address Fax Number:
601-366-9276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3454 ALBERMARLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-362-5394
Provider Business Practice Location Address Fax Number:
601-366-9276
Provider Enumeration Date:
12/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
TINA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
COMPTROLLER
Authorized Official Telephone Number:
601-304-0980

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  375 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08400599 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".