Healthcare Provider Details

I. General information

NPI: 1063673820
Provider Name (Legal Business Name): MS HUD DIXIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 MENGE AVE
PASS CHRISTIAN MS
39571-4234
US

IV. Provider business mailing address

40 PALAFOX PL SUITE 400
PENSACOLA FL
32502-5697
US

V. Phone/Fax

Practice location:
  • Phone: 228-452-4344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: SHERYL A WOLF
Title or Position: TREASURER
Credential:
Phone: 850-430-0000