Healthcare Provider Details

I. General information

NPI: 1417332040
Provider Name (Legal Business Name): BEDFORD CARE CENTER-WARREN HALL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2797 COOPER RD
PICAYUNE MS
39466
US

IV. Provider business mailing address

100 W PINE ST
HATTIESBURG MS
39401-3467
US

V. Phone/Fax

Practice location:
  • Phone: 601-799-1616
  • Fax: 601-799-0725
Mailing address:
  • Phone: 601-583-3232
  • Fax: 601-582-7539

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: MR. STEPHEN A WORREL
Title or Position: CONTROLLER
Credential:
Phone: 601-583-3232