MEDICARE: TUNICA NURSING HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	733	MS

General Provider Information

NPI Number	:	1265429971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUNICA NURSING HOME

Provider Business Mailing Address
First Line	:	1024 HIGHWAY 61 S
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-9440
Country	:	US
Telephone Number	:	662-363-3164
Fax Number	:	662-363-4191

Provider Business Practice Location Address
First Line	:	1024 HIGHWAY 61 S
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-9440
Country	:	US
Telephone Number	:	662-363-3164
Fax Number	:	662-363-4191

Authorized Official
Title or Position	:	ADMINISTRAOTR
Name	:	MRS. BARBARA DALE LENARD
Credential	:
Telephone Number	:	662-363-3164

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	08/22/2020

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Directions to “TUNICA NURSING HOME ” Practice Location

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