Healthcare Provider Details

I. General information

NPI: 1235611765
Provider Name (Legal Business Name): MS STATE VETERANS HOME COLLINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 HIGHWAY 49
COLLINS MS
39428-3876
US

IV. Provider business mailing address

3261 HIGHWAY 49
COLLINS MS
39428-3876
US

V. Phone/Fax

Practice location:
  • Phone: 601-765-0403
  • Fax: 601-765-5045
Mailing address:
  • Phone: 601-765-0519
  • Fax: 601-765-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN PHIPPS
Title or Position: PHARMACIST
Credential:
Phone: 601-765-0403