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General NPI Number Information
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NPI Number | 1245394501
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Entity Type | Organization
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Legal Business Name | WASHINGTON COUNTY LTC, INC.
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 1221 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3243
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Country | US
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Telephone | 662-335-5811
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Fax | 662-332-2551
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Provider Business Mailing Address
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Address Line | 1221 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3243
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Country | US
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Telephone | 662-335-5811
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Fax | 662-332-2551
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TESSA COOPER
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Credential |
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Telephone | 662-335-5811
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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 | 738
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License Number State | MS
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