Healthcare Provider Details

I. General information

NPI: 1710121033
Provider Name (Legal Business Name): RURAL HEALTHCARE DEVELOPERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2554 MAIN ST
PLANTERSVILLE MS
38862-7908
US

IV. Provider business mailing address

PO BOX 489
PLANTERSVILLE MS
38862-0489
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-3451
  • Fax:
Mailing address:
  • Phone: 662-840-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPENDING
License Number StateMS

VIII. Authorized Official

Name: RAY L SHOEMAKER
Title or Position: CEO
Credential:
Phone: 662-321-1155