Healthcare Provider Details

I. General information

NPI: 1780758904
Provider Name (Legal Business Name): WCRL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 WILLOW CREEK LN
BYRAM MS
39272-9255
US

IV. Provider business mailing address

PO BOX 320939
FLOWOOD MS
39232-0939
US

V. Phone/Fax

Practice location:
  • Phone: 601-863-4201
  • Fax: 601-863-4202
Mailing address:
  • Phone: 601-853-2667
  • Fax: 601-853-2116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number926
License Number StateMS

VIII. Authorized Official

Name: MR. DAVID ROTOLO
Title or Position: MEMBER
Credential:
Phone: 601-853-2667