Healthcare Provider Details

I. General information

NPI: 1144248253
Provider Name (Legal Business Name): SHEARER RICHARDSON MEMORIAL NURSINGHOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 ROCKWELL DR
OKOLONA MS
38860
US

IV. Provider business mailing address

512 ROCKWELL DR
OKOLONA MS
38860
US

V. Phone/Fax

Practice location:
  • Phone: 662-447-3311
  • Fax: 662-447-3856
Mailing address:
  • Phone: 662-447-3311
  • Fax: 662-447-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number153
License Number StateMS

VIII. Authorized Official

Name: BRENDA G WISE
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-447-3311