Healthcare Provider Details

I. General information

NPI: 1992919906
Provider Name (Legal Business Name): SENIOR CARE CENTERS OF MISSISSIPPI,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 E NORTHSIDE DR
CLINTON MS
39056-3618
US

IV. Provider business mailing address

7 NESHAMINY INTERPLEX SUITE 403
TREVOSE PA
19053
US

V. Phone/Fax

Practice location:
  • Phone: 601-926-1222
  • Fax: 601-924-3907
Mailing address:
  • Phone: 215-642-6600
  • Fax: 215-642-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CRAIG O MEHNERT
Title or Position: CFO
Credential:
Phone: 215-642-6600