Healthcare Provider Details

I. General information

NPI: 1376727818
Provider Name (Legal Business Name): TUNICA NURSING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 04/24/2008
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 TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number733
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONICA LENARD
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 662-363-3164