Healthcare Provider Details

I. General information

NPI: 1275720666
Provider Name (Legal Business Name): PICAYUNE REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 READ RD
PICAYUNE MS
39466-2710
US

IV. Provider business mailing address

1620 READ RD
PICAYUNE MS
39466-2710
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-1811
  • Fax: 601-798-2362
Mailing address:
  • Phone: 601-798-1811
  • Fax: 601-798-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number593
License Number StateMS

VIII. Authorized Official

Name: MICHELLE D MEER
Title or Position: VICE PRESIDENT & SECRETARY
Credential:
Phone: 629-626-0000