=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124168869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY CARE NURSING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 628 NORRIS ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38703-6042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-378-2009
-----------------------------------------------------
Fax | 662-378-2090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 490
-----------------------------------------------------
City | LELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38756-0490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-378-2009
-----------------------------------------------------
Fax | 662-378-2090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. HATTIE H NELSON
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 662-378-2009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | R819613
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------