Healthcare Provider Details

I. General information

NPI: 1922111004
Provider Name (Legal Business Name): UNION LTC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S GLENFIELD RD
NEW ALBANY MS
38652-2605
US

IV. Provider business mailing address

118 S GLENFIELD RD
NEW ALBANY MS
38652-2605
US

V. Phone/Fax

Practice location:
  • Phone: 662-534-9506
  • Fax: 662-534-2407
Mailing address:
  • Phone: 662-534-9506
  • Fax: 662-534-2407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number266
License Number StateMS

VIII. Authorized Official

Name: MR. GENE BENNETT HUBBARD JR.
Title or Position: OWNER
Credential:
Phone: 601-849-2294