Healthcare Provider Details

I. General information

NPI: 1407886146
Provider Name (Legal Business Name): MISSISSIPPI HOSPITAL FOR RESTORATIVE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

PO BOX 23090
JACKSON MS
39225-3090
US

V. Phone/Fax

Practice location:
  • Phone: 601-968-5130
  • Fax: 601-968-1383
Mailing address:
  • Phone: 601-968-1362
  • Fax: 601-292-4592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number23-319
License Number StateMS

VIII. Authorized Official

Name: DAVID JACKSON
Title or Position: VICE PRESIDENT/CORPORATE CONTROLLER
Credential:
Phone: 601-968-5130