Healthcare Provider Details

I. General information

NPI: 1093702144
Provider Name (Legal Business Name): QUEEN CITY NURSING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 28TH AVE
MERIDIAN MS
39301-3810
US

IV. Provider business mailing address

1201 28TH AVE
MERIDIAN MS
39301-3810
US

V. Phone/Fax

Practice location:
  • Phone: 601-483-1467
  • Fax: 601-483-1483
Mailing address:
  • Phone: 601-483-1467
  • Fax: 601-483-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number219
License Number StateMS

VIII. Authorized Official

Name: MS. BARBARA HOWARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-483-1467