Healthcare Provider Details

I. General information

NPI: 1447432612
Provider Name (Legal Business Name): INDIANOLA REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HIGHWAY 82 W
INDIANOLA MS
38751-2030
US

IV. Provider business mailing address

401 HIGHWAY 82 W
INDIANOLA MS
38751-2030
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-2682
  • Fax: 662-887-3817
Mailing address:
  • Phone: 662-887-2682
  • Fax: 662-887-3817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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