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General NPI Number Information
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NPI Number | 1053019265
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Entity Type | Organization
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Legal Business Name | EQUAL STEPS VETERANS HOME
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 305 CHURCH AVE
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City | LONG BEACH
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State | MS
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Zip | 39560-6035
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Country | US
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Telephone | 228-265-8576
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Fax |
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Provider Business Mailing Address
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Address Line | 305 CHURCH AVE
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City | LONG BEACH
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State | MS
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Zip | 39560-6035
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Country | US
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Telephone | 228-265-8576
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NEKOLE PREDIUM
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Credential |
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Telephone | 337-936-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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