Healthcare Provider Details

I. General information

NPI: 1598753436
Provider Name (Legal Business Name): UNITED METHODIST SENIOR SERVICES OF GOLDEN TRIANGLE AREA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 AIRLINE RD
COLUMBUS MS
39702-6348
US

IV. Provider business mailing address

230 AIRLINE RD
COLUMBUS MS
39702-6348
US

V. Phone/Fax

Practice location:
  • Phone: 662-327-9404
  • Fax: 662-328-1445
Mailing address:
  • Phone: 662-327-9404
  • Fax: 662-328-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number769
License Number StateMS

VIII. Authorized Official

Name: STEVE MCALILLY
Title or Position: CEO
Credential:
Phone: 662-844-8977