Healthcare Provider Details

I. General information

NPI: 1629028352
Provider Name (Legal Business Name): COVENANT HEALTH & REHAB OF PICAYUNE, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/10/2007
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: MRS. JUDY ULLERY
Title or Position: PRESIDENT
Credential:
Phone: 901-937-7994