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General NPI Number Information
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NPI Number | 1144248253
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Entity Type | Organization
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Legal Business Name | SHEARER RICHARDSON MEMORIAL NURSINGHOME
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 512 ROCKWELL DR
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City | OKOLONA
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State | MS
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Zip | 38860
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Country | US
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Telephone | 662-447-3311
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Fax | 662-447-3856
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Provider Business Mailing Address
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Address Line | 512 ROCKWELL DR
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City | OKOLONA
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State | MS
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Zip | 38860
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Country | US
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Telephone | 662-447-3311
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Fax | 662-447-3856
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BRENDA G WISE
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Credential |
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Telephone | 662-447-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 153
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License Number State | MS
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