Healthcare Provider Details

I. General information

NPI: 1790849644
Provider Name (Legal Business Name): SCOTT COUNTY LTC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 OLD HIGHWAY 80 E
MORTON MS
39117-9771
US

IV. Provider business mailing address

96 OLD HIGHWAY 80 E
MORTON MS
39117-9771
US

V. Phone/Fax

Practice location:
  • Phone: 601-732-6361
  • Fax: 601-732-2220
Mailing address:
  • Phone: 601-732-6361
  • Fax: 601-732-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1193
License Number StateMS

VIII. Authorized Official

Name: MS. BETTY MCCURDY
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-732-6361