Healthcare Provider Details

I. General information

NPI: 1467495127
Provider Name (Legal Business Name): PRENTISS REGIONAL HOSPITAL AND EXTENDED CARE FACILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 ROSE STREET
PRENTISS MS
39474-1288
US

IV. Provider business mailing address

1102 ROSE STREET P.O. BOX 1288
PRENTISS MS
39474-1288
US

V. Phone/Fax

Practice location:
  • Phone: 601-792-4276
  • Fax: 601-792-2947
Mailing address:
  • Phone: 601-792-4276
  • Fax: 601-792-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number16-179
License Number StateMS

VIII. Authorized Official

Name: MRS. MARY CURTIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 601-792-1232