Healthcare Provider Details

I. General information

NPI: 1477203396
Provider Name (Legal Business Name): DAC OF QUITMAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 HIGHWAY 511
QUITMAN MS
39355-8320
US

IV. Provider business mailing address

1621 GALLERIA BLVD
BRENTWOOD TN
37027-2926
US

V. Phone/Fax

Practice location:
  • Phone: 601-776-2141
  • Fax: 601-776-5782
Mailing address:
  • Phone: 615-550-9453
  • Fax: 615-915-9635

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: MATTHEW J. WEISHAAR
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 615-550-9459