Healthcare Provider Details

I. General information

NPI: 1609865450
Provider Name (Legal Business Name): DUGAN MEMORIAL HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 02/22/2008
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

804 E MAIN ST
WEST POINT MS
39773-3137
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 Number
License Number State

VIII. Authorized Official

Name: STEVE MCALILLY
Title or Position: CEO
Credential:
Phone: 662-844-8977