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General NPI Number Information
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NPI Number | 1538143250
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Entity Type | Organization
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Legal Business Name | BELHAVEN NURSING CENTER LLC
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 1004 NORTH ST
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City | JACKSON
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State | MS
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Zip | 39202-2433
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Country | US
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Telephone | 601-355-0763
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 NORTH ST
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City | JACKSON
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State | MS
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Zip | 39202-2433
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Country | US
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Telephone | 601-355-0763
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Fax | 601-355-9775
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Authorized Official
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Title or Position | COMPTROLLER
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Name | MRS. TINA L ELLIS
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Credential |
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Telephone | 601-304-0980
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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 | 624
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License Number State | MS
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