Healthcare Provider Details

I. General information

NPI: 1053834747
Provider Name (Legal Business Name): ST. CATHERINE'S VILLAGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DOMINICAN DR
MADISON MS
39110-8630
US

IV. Provider business mailing address

200 DOMINICAN DR
MADISON MS
39110-8630
US

V. Phone/Fax

Practice location:
  • Phone: 601-856-0100
  • Fax: 601-856-0109
Mailing address:
  • Phone: 601-856-0100
  • Fax: 601-856-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number637
License Number StateMS

VIII. Authorized Official

Name: CLAUDE W. HARBARGER
Title or Position: PRESIDENT
Credential:
Phone: 601-856-0100