Healthcare Provider Details

I. General information

NPI: 1134420284
Provider Name (Legal Business Name): DURANT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15481 BOWLING GREEN RD
DURANT MS
39063-3565
US

IV. Provider business mailing address

15481 BOWLING GREEN RD
DURANT MS
39063-3565
US

V. Phone/Fax

Practice location:
  • Phone: 662-653-4106
  • Fax: 662-653-3940
Mailing address:
  • Phone: 662-653-4106
  • Fax: 662-653-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00220267
License Number StateMS

VIII. Authorized Official

Name: MRS. TINA ELLIS
Title or Position: COMPTROLLER
Credential:
Phone: 601-304-0980