Healthcare Provider Details

I. General information

NPI: 1922056050
Provider Name (Legal Business Name): SHARKEY-ISSAQUENA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 WEST RACE STREET
ROLLING FORK MS
39159
US

IV. Provider business mailing address

431 WEST RACE STREET
ROLLING FORK MS
39159
US

V. Phone/Fax

Practice location:
  • Phone: 662-873-6218
  • Fax: 662-873-6050
Mailing address:
  • Phone: 662-873-6218
  • Fax: 662-873-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number539
License Number StateMS

VIII. Authorized Official

Name: MR. STEVEN G. KEEVER
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-873-4395