Healthcare Provider Details

I. General information

NPI: 1700872579
Provider Name (Legal Business Name): MEADVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HIGHWAY 556
MEADVILLE MS
39653
US

IV. Provider business mailing address

300 HIGHWAY 556
MEADVILLE MS
39653
US

V. Phone/Fax

Practice location:
  • Phone: 601-384-5861
  • Fax: 601-384-5862
Mailing address:
  • Phone: 601-384-5861
  • Fax: 601-384-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number603
License Number StateMS

VIII. Authorized Official

Name: REBECCA A RYLEE
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 601-384-5861