Healthcare Provider Details

I. General information

NPI: 1619109535
Provider Name (Legal Business Name): LTAC HOSPITAL OF GREENWOOD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 RIVER RD 2ND FLOOR
GREENWOOD MS
38930-4030
US

IV. Provider business mailing address

101 LA RUE FRANCE STE 500
LAFAYETTE LA
70508-3144
US

V. Phone/Fax

Practice location:
  • Phone: 662-451-5172
  • Fax:
Mailing address:
  • Phone: 337-269-9566
  • Fax: 337-269-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA L MCGEE
Title or Position: CFO
Credential:
Phone: 337-269-9566