Healthcare Provider Details

I. General information

NPI: 1023297173
Provider Name (Legal Business Name): GREENE COUNTY NURSING AND REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 JACKSON AVE
LEAKESVILLE MS
39451-9105
US

IV. Provider business mailing address

PO BOX 115
WIGGINS MS
39577-0115
US

V. Phone/Fax

Practice location:
  • Phone: 601-394-4135
  • Fax:
Mailing address:
  • Phone: 601-928-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS WAYNE KULUZ
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 601-928-2911