Healthcare Provider Details

I. General information

NPI: 1134711450
Provider Name (Legal Business Name): TREND HEALTH AND REHAB OF BROOKHAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BROOKMAN DR
BROOKHAVEN MS
39601-2326
US

IV. Provider business mailing address

125 FOUNTAINS BLVD
MADISON MS
39110-6344
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-2330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES BRUCE KELLY
Title or Position: MANAGING MEMBER
Credential:
Phone: 601-499-0899