Healthcare Provider Details

I. General information

NPI: 1467400242
Provider Name (Legal Business Name): COLUMBIA COMMUNITY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 ALBERTA AVE
COLUMBIA MS
39429-2552
US

IV. Provider business mailing address

1018 ALBERTA AVE
COLUMBIA MS
39429-2552
US

V. Phone/Fax

Practice location:
  • Phone: 601-731-1745
  • Fax: 601-736-3886
Mailing address:
  • Phone: 601-731-1745
  • Fax: 601-736-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number464
License Number StateMS

VIII. Authorized Official

Name: MRS. TONI PARKINSON
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 601-709-1408