Healthcare Provider Details

I. General information

NPI: 1821183955
Provider Name (Legal Business Name): GREENE RURUAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 JACKSON AVE
LEAKESVILLE MS
39451-9105
US

IV. Provider business mailing address

1017 JACKSON AVE
LEAKESVILLE MS
39451-9105
US

V. Phone/Fax

Practice location:
  • Phone: 601-394-2371
  • Fax: 601-394-5495
Mailing address:
  • Phone: 601-394-2371
  • Fax: 601-394-5495

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: MRS. WANDA FAY HUNT
Title or Position: FACILITY ADMINISTRATOR
Credential:
Phone: 601-394-2371