Healthcare Provider Details

I. General information

NPI: 1578545646
Provider Name (Legal Business Name): BEDFORD CARE CENTER-MONROE HALL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CAHAL ST
HATTIESBURG MS
39401-2922
US

IV. Provider business mailing address

100 W PINE ST
HATTIESBURG MS
39401-3467
US

V. Phone/Fax

Practice location:
  • Phone: 601-582-9157
  • Fax: 601-582-2639
Mailing address:
  • Phone: 601-583-3232
  • Fax: 601-582-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number951
License Number StateMS

VIII. Authorized Official

Name: MR. STEPHEN A. WORREL
Title or Position: CONTROLLER
Credential:
Phone: 601-583-3232