Healthcare Provider Details

I. General information

NPI: 1265429971
Provider Name (Legal Business Name): TUNICA NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 HIGHWAY 61 S
TUNICA MS
38676-9440
US

IV. Provider business mailing address

1024 HIGHWAY 61 S
TUNICA MS
38676-9440
US

V. Phone/Fax

Practice location:
  • Phone: 662-363-3164
  • Fax: 662-363-4191
Mailing address:
  • Phone: 662-363-3164
  • Fax: 662-363-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number733
License Number StateMS

VIII. Authorized Official

Name: MRS. BARBARA DALE LENARD
Title or Position: ADMINISTRAOTR
Credential:
Phone: 662-363-3164