Healthcare Provider Details

I. General information

NPI: 1205823812
Provider Name (Legal Business Name): CARE CENTER OF LOUISVILLE, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 E MAIN ST
LOUISVILLE MS
39339-2709
US

IV. Provider business mailing address

PO BOX 542
LOUISVILLE MS
39339-0542
US

V. Phone/Fax

Practice location:
  • Phone: 662-773-8047
  • Fax: 662-773-2530
Mailing address:
  • Phone: 662-773-8047
  • Fax: 662-773-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number562
License Number StateMS

VIII. Authorized Official

Name: MISS DEBORAH GWIN WHITE
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-773-8047