Healthcare Provider Details

I. General information

NPI: 1083788053
Provider Name (Legal Business Name): LAKELAND NURSING AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 LAKELAND LN
JACKSON MS
39216-4707
US

IV. Provider business mailing address

PO BOX 428
ORCHARD PARK NY
14127-0428
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-5505
  • Fax: 601-362-1883
Mailing address:
  • Phone: 716-662-4955
  • Fax: 716-667-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number385
License Number StateMS

VIII. Authorized Official

Name: MR. NORBERT A BENNETT
Title or Position: CO-CHIEF EXECUTIVE OFFICER
Credential:
Phone: 716-662-4955