Healthcare Provider Details

I. General information

NPI: 1760434724
Provider Name (Legal Business Name): GREAT OAKS REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CHASE ST
BYHALIA MS
38611-7395
US

IV. Provider business mailing address

111 CHASE ST
BYHALIA MS
38611-7395
US

V. Phone/Fax

Practice location:
  • Phone: 662-838-3670
  • Fax: 662-838-3740
Mailing address:
  • Phone: 662-838-3670
  • Fax: 662-838-3740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number984
License Number StateMS

VIII. Authorized Official

Name: MICHELLE D MEER
Title or Position: VICE PRESIDENT AND SECRETARY
Credential:
Phone: 629-262-0000