Healthcare Provider Details

I. General information

NPI: 1932278231
Provider Name (Legal Business Name): YALOBUSHA COUNTY NURSING HOME DBA YALOBUSHA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S MAIN ST
WATER VALLEY MS
38965-3468
US

IV. Provider business mailing address

630 S MAIN ST
WATER VALLEY MS
38965-3468
US

V. Phone/Fax

Practice location:
  • Phone: 662-473-1411
  • Fax: 662-473-4922
Mailing address:
  • Phone: 662-473-1411
  • Fax: 662-473-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number224
License Number StateMS

VIII. Authorized Official

Name: MS. BONNIE JEAN HELM
Title or Position: NURSING HOME INSURANCE
Credential:
Phone: 662-473-1411