Healthcare Provider Details

I. General information

NPI: 1336136241
Provider Name (Legal Business Name): DUGAN MEMORIAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 E MAIN ST
WEST POINT MS
39773-3137
US

IV. Provider business mailing address

PO BOX 698
WEST POINT MS
39773-0698
US

V. Phone/Fax

Practice location:
  • Phone: 662-494-3640
  • Fax: 662-494-3641
Mailing address:
  • Phone: 662-494-3640
  • Fax: 662-494-3641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number178
License Number StateMS

VIII. Authorized Official

Name: MS. TAMMY SHEA MARTIN
Title or Position: EXECUTIVE DIRECTOR
Credential: ADMINISTRATOR
Phone: 662-494-3640