Healthcare Provider Details

I. General information

NPI: 1336199058
Provider Name (Legal Business Name): HOLLY SPRINGS REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 HIGHWAY 4 E
HOLLY SPRINGS MS
38635-2112
US

IV. Provider business mailing address

1315 HIGHWAY 4 E
HOLLY SPRINGS MS
38635-2112
US

V. Phone/Fax

Practice location:
  • Phone: 662-252-1141
  • Fax: 662-252-4836
Mailing address:
  • Phone: 662-252-1141
  • Fax: 662-252-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number504
License Number StateMS

VIII. Authorized Official

Name: MICHELLE D MEER
Title or Position: VICE PRESIDENT & SECRETARY
Credential:
Phone: 629-626-0000