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General NPI Number Information
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NPI Number | 1205961810
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Entity Type | Organization
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Legal Business Name | DYNAMIC COLUMBIA OPERATING COMPANY LLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1506 NORTH MAIN STREET
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City | COLUMBIA
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State | MS
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Zip | 39429-2070
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Country | US
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Telephone | 601-736-9557
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Fax | 601-736-9903
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Provider Business Mailing Address
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Address Line | 1506 NORTH MAIN STREET
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City | COLUMBIA
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State | MS
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Zip | 39429-2070
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Country | US
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Telephone | 601-736-9557
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Fax | 601-736-9903
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MRS. SHIRLEY S BROWN
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Credential |
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Telephone | 601-736-9557
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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 | 507
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License Number State | MS
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