Healthcare Provider Details

I. General information

NPI: 1427708338
Provider Name (Legal Business Name): DAC OF MOSS POINT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 MAIN ST
MOSS POINT MS
39563-5101
US

IV. Provider business mailing address

1621 GALLERIA BLVD
BRENTWOOD TN
37027-2926
US

V. Phone/Fax

Practice location:
  • Phone: 228-762-7451
  • Fax: 228-769-2294
Mailing address:
  • Phone: 615-550-9400
  • Fax: 615-620-7875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW J. WEISHAAR
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 615-550-9459