Healthcare Provider Details

I. General information

NPI: 1467410449
Provider Name (Legal Business Name): WOODLANDS REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WOODCHASE PARK DR
CLINTON MS
39056-4113
US

IV. Provider business mailing address

102 WOODCHASE PARK DR
CLINTON MS
39056-4113
US

V. Phone/Fax

Practice location:
  • Phone: 601-924-7043
  • Fax: 601-924-8633
Mailing address:
  • Phone: 601-924-7043
  • Fax: 601-924-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number499
License Number StateMS

VIII. Authorized Official

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