Healthcare Provider Details

I. General information

NPI: 1265449367
Provider Name (Legal Business Name): WINDSOR PLACE NURSING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 WINDSOR BLVD
COLUMBUS MS
39702
US

IV. Provider business mailing address

81 WINDSOR BLVD
COLUMBUS MS
39702
US

V. Phone/Fax

Practice location:
  • Phone: 662-241-5518
  • Fax: 662-241-5590
Mailing address:
  • Phone: 662-241-5518
  • Fax: 662-241-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number865
License Number StateMS

VIII. Authorized Official

Name: MR. OLIVER LESTER PHILLIPS JR.
Title or Position: CEO
Credential:
Phone: 662-241-5518