Healthcare Provider Details

I. General information

NPI: 1861674038
Provider Name (Legal Business Name): DELTA REHABILITATION AND HEALTHCARE CENTER OF CLEVELAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MARTIN LUTHER KING DR
CLEVELAND MS
38732-2821
US

IV. Provider business mailing address

200 N MARTIN LUTHER KING DR
CLEVELAND MS
38732-2821
US

V. Phone/Fax

Practice location:
  • Phone: 662-843-5347
  • Fax: 662-843-0751
Mailing address:
  • Phone: 662-843-5347
  • Fax: 662-843-0751

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: MICHELLE D MEER
Title or Position: VICE PRESIDENT & SECRETARY
Credential:
Phone: 629-626-0000