Healthcare Provider Details

I. General information

NPI: 1093811903
Provider Name (Legal Business Name): CALHOUN HEALTH SERVICES NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 BURKE CALHOUN CITY RD
CALHOUN CITY MS
38916
US

IV. Provider business mailing address

152 BURKE CALHOUN CITY RD
CALHOUN CITY MS
38916
US

V. Phone/Fax

Practice location:
  • Phone: 662-628-6611
  • Fax: 662-628-5707
Mailing address:
  • Phone: 662-628-6611
  • Fax: 662-628-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1084
License Number StateMS

VIII. Authorized Official

Name: MANDY SUBER
Title or Position: DIRECTOR OF FISCAL SERVICES
Credential:
Phone: 662-628-6611