Healthcare Provider Details

I. General information

NPI: 1356587208
Provider Name (Legal Business Name): LOUISVILLE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 12/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 EAST MAIN STREET
LOUISVILLE MS
39339
US

IV. Provider business mailing address

323 HIGHLAND BLVD
NATCHEZ MS
39120
US

V. Phone/Fax

Practice location:
  • Phone: 662-773-8047
  • Fax:
Mailing address:
  • Phone: 601-304-0980
  • Fax:

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