Healthcare Provider Details

I. General information

NPI: 1215170832
Provider Name (Legal Business Name): BEDFORD CARE CENTER OF MARION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6434A DALE DR
MARION MS
39342-8704
US

IV. Provider business mailing address

100 W PINE ST
HATTIESBURG MS
39401-3467
US

V. Phone/Fax

Practice location:
  • Phone: 601-294-3515
  • Fax: 601-693-3198
Mailing address:
  • Phone: 601-583-3232
  • Fax: 601-582-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number524
License Number StateMS

VIII. Authorized Official

Name: MR. MICHAEL E MCELROY JR.
Title or Position: VICE PRESIDENT
Credential:
Phone: 601-583-3232