Healthcare Provider Details

I. General information

NPI: 1700860426
Provider Name (Legal Business Name): LEXINGTON MANOR NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 ROCKPORT RD
LEXINGTON MS
39095-5166
US

IV. Provider business mailing address

56 ROCKPORT RD
LEXINGTON MS
39095-5166
US

V. Phone/Fax

Practice location:
  • Phone: 662-834-3021
  • Fax: 662-834-4848
Mailing address:
  • Phone: 662-834-3021
  • Fax: 662-834-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number614
License Number StateMS

VIII. Authorized Official

Name: MRS. TINA L ELLIS
Title or Position: COMPTROLLER
Credential:
Phone: 601-304-0980